Mr. President, I rise in support of the amendment proposed by my leader, the Senator from South Dakota. I think it is important to review briefly the history that brought us to this point today. A few hundred years ago, before the first…
Mr. President, I rise in support of the amendment proposed by my leader, the Senator from South Dakota.
I think it is important to review briefly the history that brought us to this point today.
A few hundred years ago, before the first Europeans landed on the shores of what is now the United States, the Indian nations exercised dominion and control over 550 million acres of the land which became America.
By the time of the Revolutionary War, relations with the Indian tribes were well established, and it was the Native people of this land who provided food to General George Washington and his troops that sustained them throughout the harsh winter at Valley Forge.
Native warriors fought beside the revolutionary soldiers, and their valuable contributions to the success of the war for independence was widely chronicled.
Later, as our Founding Fathers undertook the task of developing a constitution for a new Nation, it was the governmental structure of the Iroquois Confederacy that they chose as the model for our democracy and the foundation of our government.
In contemporary times, more Indian men and women, on a per capita basis, have put on the uniform of our country and placed themselves in harm's way in defense of our country than any other ethnic group.
This dedication to a nation that has many sad and sorry chapters in its history of relations with the Native people of this land is remarkable.
Nonetheless, Indian people have served in the Armed Forces of the United States in greater numbers than any other segment of the population, on a per capita basis, in World War II, the Korean War, the Vietnam War, the Gulf War and Desert Storm, and in every military action in which our country has been engaged in modern times.
These are the people whose ancestors ceded 500 million acres of land to America, in exchange for certain fundamental commitments on the part of the United States, including the provision of health care.
So, as has been observed more than once in this Chamber, the Native people of the United States has paid their dues.
They have sacrificed their sons and daughters, mothers and fathers, uncles and aunts in the defense of our Nation.
And through their treaties with the United States, and their cession of millions of acres of land to the United States, the Native people of this land purchased the first prepaid health plan in America.
The question that we are confronted with today is: What promises did the United States make to the Native people of America in treaties and what responsibilities did the United States undertake in subsequently enacted Federal laws, and how do those commitments measure up to what is provided to other Americans today in the arena of health care services?
I believe that the reason my colleague from South Dakota has come forward today with his amendment is that he sees in his home State of South Dakota the same dynamic that we see across Indian country--a health care system that is woefully underfunded and alarmingly understaffed, with facilities that are in such a state of disrepair that many of them have been condemned.
As a veteran and as ranking member of the Defense Appropriations subcommittee, I have had the opportunity to compare the investments our Nation makes in the health care provided to our veterans, to our men and women in active duty service and their dependent, and to our Federal employees.
I think these comparative expenditures should interest our colleagues--for they tell the story and paint a dramatic picture of disparities that are so large and frankly, so shocking, that we would be negligent and irresponsible were we to fail to address them.
Let's look at veterans. The Veterans' Administration expended $5,214 for medical care for each eligible veteran in 2001. In 1999, Medicare expended $5,915 per eligible Medicare enrollee.
The average medical expenditure in the United States on a per capita basis in 1999 was $5,065 per patient.
For Medicaid enrollees, $3,879 was expended for each eligible Medicaid patient in 1998.
For inmates in Federal prisons, $3,803 were expended for health care services provided to each inmate in 1999.
Just a little less--$3,725--was provided to Federal employees in 1999 for health care services under an eligible Federal health care plan.
Compare all of these figures with that provided to patients of the Indian Health Service in 2002--a shocking $1,914 per patient for medical care and $619 for nonmedical care such as preventive health care services.
So if you are an Indian person and you are in need of health care services, you would have twice as much provided for your health care as a Federal prison inmate than you would as a law-abiding Native citizen of the United States.
If you were a veteran, 60 percent more would be dedicated to providing health care to you, and if you were eligible for Medicare, the percentage would be even higher.
This is the relative nature of the manner in which we carry out our commitments to the Native people of this land.
Now let's look at some health statistics of the Native American population. If you are an Indian or an Alaska Native, the likelihood that you will die from diabetes is 390 percent higher than for other Americans.
As a Native person, your chances of dying from tuberculosis are 500 percent higher than other Americans.
And if you are a newborn or an infant Native child, your mortality rate is 25 percent higher than other infants.
Rates of cardiovascular disease are twice those for the general public and they continue to increase while the incidence of cardiovascular disease is going down amongst the general population.
To complete this picture, we also need to look at the health care system that is designed to serve the needs of Native people.
Health care in Native America is provided through the Indian Health Service system of hospitals and clinics, through tribally operated hospitals and clinics, through urban Indian health care programs, and through government contracts with private hospitals and health care providers.
In some of the most heavily populated areas of Indian country, particularly California, Oregon, and Washington State, there are no Indian Health Service hospitals and clinics, so Native people in those states must rely on either a tribal health care system or on contract health care services.
But because of the severe constraints that have been imposed on funds available for the purchase of contract health care services, those who must seek care outside the Indian Health Service system have to prove that their condition is either life-threatening or that they may lose a limb in the absence of treatment.
So if you have severe diabetes and resultant kidney damage, for example, as a Native person you wouldn't be eligible for kidney dialysis until you were at death's door. Physicians would instruct us that by that time, it is often too late to save the life of a patient.
In this category alone, there is a shortfall of $20.6 million of what is needed for contract health care services.
To bring the 55 most poorly funded tribal health care systems up to 40 percent of the identified health care needs, it would require $34 million.
And to bring tribal communities across the Nation up to just 60 percent of the identified health care needs, it would require $388 million.
The Indian Health Service is also charged with providing safe water and sanitation facilities for Indian communities, but there is a $1.753 billion backlog in sanitation facilities.
For basic primary health care services--services which most Americans take for granted because their access is unlimited--for Native people the need that is unmet is $6.336 billion.
For Indian people suffering from cancer, the health care service need that is currently unmet is $294 million.
For those Native patients with heart disease, the unmet need for health care services is $369 million.
Native Americans with diabetes have an unmet need for health care treatment of $452 million.
I could go on and on with such tragic statistics--and if they were just numbers it might be a different matter--but each of these statistics represents thousands of Native people who are going without the most fundamental health care.
These are the people who have given this country their land so that we could build a new nation.
These are the people who have sacrificed their lives in the defense of our country.
These are the people who have given the most and who are in turn, provided the least.
Most of the Indian Health Service hospitals are over 30 years old. They are so badly in need of repair and replacement that the minimum unmet need is $610 million.
Year after year, the costs associated with providing care--salaries of doctors and nurses and other health care professionals serving Indian country--fail to keep pace with those employed in the Department of Defense and Veterans' Administration health care systems, or with medical inflation rates.
Not surprisingly, these valued professionals leave Indian country for more pay, better working conditions, and as caring people--for the promise that the patients they see on a daily basis won't have to wait until their lives are hanging in the balance before they can receive care.
If treaties mean anything--and the U.S. Supreme Court has repeatedly held that treaties are the highest laws of the land--then this Nation has not only a moral duty but a legal obligation to fulfill its treaty commitments to the Native people of this land.
And I think that these numbers make it abundantly clear why the amendment proposed by my friend from South Dakota is conservative.
It won't meet all of the health care needs in Indian country, but it would be a good beginning in addressing conditions that are devastating and tragic by any measure--conditions which portray a shameful picture that a benevolent and prosperous nation appears to care so little about its First Americans.