Indian reservations are designated areas for the Native Americans (Indian American and Alaska Natives). The areas were designated through an executive order after the natives surrendered their lands and this entitled them to free health care service under the Indian Health Care system.
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The Indian Healthcare System has been facing a major challenge and that is chronic underfunding. This health care system has been underfunded for a long time that even if the government was to increase the budget it cannot adequately address the healthcare needs of the Indian Americans. The chronic underfunding has not only made health care service under this system inaccessible but also inadequate to the natives living on reservations.
This is a complete contrast to the federal health care system. Therefore, the U.S government must consider changing the mechanism of funding Indian Health Care System from a discretionary program to mandatory appropriation whose budget is reviewed annually.
American Indian reservations are designated land areas that are under the Native Americans (Castle and Robert 2). There are approximately Indian reservations in the U.S according to the U.S Department of Internal Affairs. This means that not all the 500 plus recognized tribes are under the reservation or share reservations (Frantz, 5).
Indian reservations were established in the early 1850s after the passing of the appropriation bill and the executive order which allowed for the creation of reservations for the Native Americans. The reservations were fronted as solutions to the brewing conflict between the natives and the settlers. The former were increasingly encroaching into the native’s territory (Castle and Robert 3).
The Indian reservation policy became contentious just from the beginning. These reservations were set up through an executive order which forced white settlers to surrender their lands and the natives forced into the reservation areas. The white settlers strongly opposed this policy (Frantz, 7).
On the other hand, numerous reports submitted to the U.S federal government revealed massive corruption among those who were in charge of resettling the Native Indians into the reservation areas. In addition, the relocated tribes were living in poor and deplorable conditions compared to the white settlers (Castle and Robert 3).
The reservations led to the increased alienation of Native Americans by the white settlers and other non-natives. The controversies surrounding India reservations have continued up to date and they encompass various aspects including socio-economic, cultural and environmental dimensions (Frantz, 8).
The quality of life within a number of these reservations is similar to developing economies. The infant mortality rate is high, life expectancy is low compared to the rest of the country, nutrition is poor, and the level of poverty is alarming. Some of the Indian reservations, for instance, South Dakota and Shannon County are among the poorest in the U.S (Frantz, 9).
According to many studies in the U.S, the highest numbers of the poor are found in the urban slums dominated by African-Americans (also known as ghettos). The second highest numbers are found in the reservation areas predominantly occupied by the Indian Americans or the Native Americans. The infrastructure and social amenities in both the ghetto and reservation areas are arguably poor.
In addition, the mortality rate (especially infant mortality) is relatively high coupled with low life expectancy. These are mainly attributed to the healthcare system in these areas. The purpose of this study is to explore the health care system on Indian reservations and compare it with the healthcare system of white Americans.
General Status of the Native Americans
The Native Americans here are the Indian Americans and Alaska Natives. About 1.5 percent of the total U.S population identifies themselves as having Native American heritage. Currently, most of these people live in urban, suburban or non-reservation countryside areas. Only a third lives in the reservation areas.
In the last three decades, most of the American Indians and Alaska Natives have migrated to metropolitan areas. The federal government recognizes about 564 American Indian and Alaska Native tribes. The native tribes have incredible cultural diversity and speak over 200 languages. (Graham 12).
Majority of the Indian Americans and Alaska Natives live in poverty. According to the statistics, more than twice as many American Indians and Alaska Natives live in poverty compared to the rest of the American population. In other words, the general level of poverty in the U.S is estimated to be about 12 percent.
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On the other hand, the poor American Indians and Alaska Natives are approximately 26 percent of the total number of Native Americans (Graham 14). The life expectancy of Native Americans is also low. The life expectancy of the American Indian and Alaska Natives are 6 years lower than the average American. The mortality rate among infants is also high compared to the rest of the American population (Singer 5).
Indian Health Care System
The two main links between the federal government and the Native Indians are the Department of Indian Affairs and the Indian Health Service. The Indian healthcare system is a wide organizational structure that encompasses services that are offered directly by the federal IHS, tribal programs, and metropolitan Indian clinics.
The Indian Health Care System is normally considered as prepaid because of the land surrendered by the tribes in 800 consented agreements and government executive orders. Therefore, Indians living in reservation areas are not supposed to be charged health care services (Graham 15).
The provision of healthcare for Native Americans falls under the federal trust responsibility of the U.S supreme law. The U.S constitution recognizes the government’s obligation to the Indian tribal governments or Indian Americans living on reservations.
Given the constitutional recognition of the state obligation to the tribal government, there has been mutual respect between the two governments and they are working together on a culturally sound health care system. However, the major deficiency of this system is the persistent underfunding of the state (Institute of Medicine 4).
Unlike other federal health care systems, the Indian Health Care System depends on discretional appropriations from the government budget. The funds are insufficient and can only meet 60 percent of the need. Approximately a quarter of the Indian Health Care System (IHS) clinical service budget originates from the Medicaid, whereas less than one percent of the Medicaid expenditure goes to the IHS (Graham 15).
Any individual who is an offspring of a Native American qualifies under this system. Slightly over 1.9 million Native Americans meet these requirements and about 1.65 million are regular users of the Indian Health Care System (US Census 3).
The Indian healthcare system is comprised of 50 hospitals, approximately 250 healthcare center, 5 referral hospitals, 300 health stations, and 34 metropolitan clinics, in addition to satellite clinics and community health center (US Census 3). Access to crucial, specialized, and emergency services and long term care are restricted by geographical factors and persistent underfunding.
Additional budget cuts may result in further rationing of the healthcare services in these hospitals. Given the fact that Indian Health Care Programs are comparatively ambiguous and are small in size, the consequences of the budget cuts have often gone unnoticed or ignored by the policymakers (Institute of Medicine 9).
Even though the federal government has always supported the Indian Healthcare System since the early 1850s, the health status of the Native Americans has continued to worsen compared to Average Americans.
This is attributed to chronic underfunding from the federal government, high level of poverty among the Native Americans, high illiteracy level, poor housing, and poor transport system. The most common ailments among the natives are obesity and diabetes. This is shocking since these diseases can be prevented or cured (Graham 17).
Indian Health Care System versus the White Health Care System
Most of the Non-native whites in the U.S have health insurance cover compared to the Indian Americans and Alaska Natives. According to the U.S. National Institute of Medicine, the uninsured Americans including the Native Americans can only access half of the medical care available to the insured whites.
The Indian Health Service is discretional and has a low budget. This means that it is inadequate (rationed) and inaccessible to the majority of Native Americans. On the other hand, the enormous budget is allocated to the white healthcare system because of their contribution.
The white healthcare system has adequate facilities and infrastructure. In addition, given the fact that most white non-native Americans are medically insured they have full access to health services in these facilities (Institute of Medicine 13).
Civil rights activists view the low budgetary allocation and rationed health care services for the Native Americans as blatant discrimination (Institute of Medicine 13). The Civil Rights Commission’s 2004 report compared Indian Health Care System and Health Cares Systems including the Medicare, Medicaid, federal prisoners, and veteran healthcare service among others.
The report established the health care system for the Native Americans was far way below the federal medical programs. One of the shocking revelations on that report was the fact that the Indian Healthcare Service per capita appropriation in 2003 was half the amount of the federal per capita allocation of the federal prisoners (Institute of Medicine 6).
Another shocking revelation was the fact U.S government had spent billions of dollars to build more health facilities and to provide health care services in Iraq at the expense of doing the same for the Native Americans. Singer compares the healthcare facilities for American Natives living on reservations to those of third world countries (Singer 3).
He adds that the disparity of the Indian Healthcare System and the federal health care system reached a crisis level and the consequences to the American Natives are gross. The shocking disparity is evident in the health of the Native Americans and the White non-natives.
The American Indians are 720 percent of succumbing to alcohol-related causes than white Americans. They are also 650 percent and 420 percent more likely to succumb to tuberculosis and diabetes respectively than whites (Singer 9).
The Indian American population has a higher probability of contracting dental carries due to inaccessible dental care. In addition, the number of Indian Americans with Dental Caries is three times higher than the whites.
This statistic reveals the growing disparity between the White Healthcare system and India Health care system which is basically broken. Therefore, the U.S government faces major and intricate challenges in ensuring a world-class health care system for all (Singer 10).
Reasons for the Disparity
U.S economists and medical experts argue that the solution to the disparity between the two medical systems goes beyond the budgetary allocation. They stress that there is no quick remedy for this problem since the factors that have caused the disparity are complex and interrelated.
Due to poverty, Indian Americans are less probable to have health insurance or a personal doctor, making regular visits less probable. Many of the individuals who don’t have health insurance in the U.S have no choice or power over the kind of medical service they receive. In addition, the poor living conditions facing most Indian Americans do expose them to many health hazards.
The current financial crisis facing the U.S and the rest of the world has limited the ability of the federal government to increase to improve its health care system. In addition, the growing population and increased cost of health care is also contributing to a huge gap between the required health care service and the available healthcare service (Devi 11).
However, the healthcare budget for the Indian Healthcare System has been growing at a slower rate than other federal healthcare budgets. Even with the Amendment of the Indian Health Care law in 1979, health care service for Indian Americans and Alaska Natives still remains substandard three decades later. Congress has failed to tremendously in enforcing the amendments (Institute of Medicine 12).
Human rights activists state that the disparity existing between the Indian Health Care system and the federal healthcare system violates the very American principle of justice and equity. Many Native Americans have lost their lives as a result of the broken health care system that keeps getting worse with time (Graham 17).
The U.S Congress has become so used to the chronic underfunding of the Indian Healthcare System to an extent that they are failing to recognize the consequences or the tragedy facing the Native Americans as a result of their actions. Some argue that the tragedy caused by these persistent budget cuts has grown so big that they are afraid of tackling them. Nonetheless, the U.S government can afford to renege on its responsibility (Devi 7).
The Indian Healthcare System was established in the early 1850s to cater for the Native Americans. Most of the Natives Americans live in poor conditions which are comparable to those that exist in developing economies. The Indian Health Care System is free of charge and is as a result of a treaty signed between the Natives and the federal government for surrendering their tribal land.
However, the problem with this system is that it has persistently been underfunded by the federal government. The chronic underfunding has led to inaccessible and inadequate health care services to the Natives. On the other hand, the Healthcare System for White Americans is the opposite of the Indian Health Care system.
They enjoy huge budgetary allocations and provide adequate medical care to all the patients. The disparity between the two systems is evident in the general health status of the Indian Americans and the Alaska Natives compared to the whites. The latter has a low life expectancy and a high mortality rate.
Castle, George P., and Robert L. Bee. State and Reservation: New Perspectives on Federal Indian Policy. Ed., Tucson: University of Arizona Press, 1992. Print.
Devi, Sridhar. Inequality in the United States Healthcare System, Oxford; UNDP, 2005. Print.
Frantz, Klaus. Indian Reservations in the United States, Chicago: University of Chicago Press, 1999. Print.
Graham, Katherine. A National Roundtable on the Indian Health System and Medicaid Reforms, Washington, DC: Urban Institute, 2005. Print.
Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, Washington, DC: National Academies Press, 2002. Print.
Singer, Michelle J. Health Care Disparities and the Native American Community, Washington, DC: U.S. Department of Health and Human Services, 2005. Print.
US Census. American Indian, Alaska Native Tables from the Statistical Abstract of the United States: 2004‐2005. PDF file. 02 Dec. 2012. www.census.gov/statab/www/sa04aian.pdf >.