[Congressional Record Volume 152, Number 135 (Friday, December 8, 2006)]
[Senate]
[Pages S11578-S11580]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           INDIAN HEALTH CARE

  Mr. DORGAN. Mr. President, I rise to talk about a piece of 
legislation that is not getting completed, and I will do that in a 
moment.
  I thank my colleague from Wyoming and others for the work they have 
just completed with respect to the issue of family care and family 
support. It is a very important piece of legislation.
  I listened to my colleague from Oklahoma talk about a number of 
important issues.
  Regarding the issue of health care, clearly we have to deal with the 
health care issue. He mentioned the amount of money spent on health 
care. It is true, we spend more money per person than anybody in the 
world, by far. And by the way, we rank 48th in life expectancy. Yes, 
48th--not 20th or 2nd but 48th in life expectancy, a country which 
spends far more than any other country per person in the world on 
health care. We have a lot to do on health care.
  With respect to fiscal policy, my colleague raises an important point 
about things that come to the Senate--proposals, ideas--that are not 
paid for. He raises an important point. They should be paid for.
  The largest area of that kind of expenditure, by the way, in recent 
years, has come at the request of the President. Nearly $400 billion, 
now, is the cost for the war in Iraq, Afghanistan, and the fight 
against terrorism. None of it is paid for. We have sent America's sons 
and daughters to war, wearing America's uniform, and essentially said 
to them: By the way, go fight; when you come back, you can pay the 
bills because the President has not asked and this Congress has not had 
the courage to decide we ought to pay for that which we spend. That 
does need to change.
  I noticed this morning in the Washington Post an article by a man 
named Samuelson, apparently an economist. I have read some of what he 
has said over the years. He talks about the value of the dollar 
slipping, decreasing, and its consequences on our country. He described 
all the reasons except the real reason. The real reason our dollar has 
decreased in value is we have an unsustainable trade deficit of $800 
billion a year, $2 billion a day, day after day after day. That is 
unsustainable and will, without question, jeopardize this country's 
future. It will have a profound influence on the value of the dollar 
with respect to the value of our currency. That will have an influence 
on virtually everything else in this country.
  So we have to get our hands around this issue of international trade 
and start demanding and insisting on fair trade, start deciding with 
our trading partners--China and other countries, Japan, South Korea, 
Europe--that we are not going to allow these dramatic trade imbalances 
to occur. They will have dramatic impact on this country's economic 
future. I will have more to say about that at another time.
  Because there was discussion about health care in the Senate, I 
wanted to speak about something that isn't getting done today, and it 
is a real tragedy. I use the word ``tragedy'' because it is the right 
word to use about this issue.
  Senator John McCain and I have worked as chairman and vice chairman 
of the Indian Affairs Committee all of this session of the Congress to 
try to pass a piece of legislation called the reauthorization of the 
Indian Health Care Improvement Act. We come to the end of the session 
without progress, unfortunately.
  Senator McCain has done great work on this issue. My other 
colleagues--I notice my colleague from Wyoming, who is in the Chamber--
have worked with us on this issue. The Indian Health Care Improvement 
Act should have been done, should have been passed. We come to the end 
of another session of the Congress and it is not getting done. There is 
a reason for that. We have written legislation that is bipartisan, and 
day after day after day, month after month, the agencies and the 
administration have objected.
  Let me describe what we face with respect to Indian health care. A 
good many American Indians, Native Americans, live in Third World 
conditions. I have spoken about it many times on the floor of the 
Senate. They live in Third World conditions inside this country. I have 
spoken about the grandmother who lay down in this country on a cot in a 
house and froze to death. It is in this country. Read that story and 
then ask yourself: What backward Third World country did that occur in? 
It occurred in this country.
  The fact is, whether it is health care or housing or education, we 
face a bona fide crisis on Indian reservations. We have a 
responsibility, what is called a trust responsibility, for Indian 
health care. We spend twice as much per person as a country to provide 
health care for Federal prisoners as we do for Native Americans for 
whom we have a trust responsibility. They get half the support we 
provide to Federal prisoners for health care.
  Talk to the Indian Health Service. They will not give you this number 
willingly, but talk to them long enough and they will tell you, 
finally, that 40 percent of the health care needs of Native Americans 
living on Indian reservations is unmet. That is health care rationing.
  Now, let me describe, if I might, just the consequences of that 
rationing, perhaps, by telling you of some real people. We had a tribal 
chairman who testified before our committee who said: On our 
reservation it is widely known, don't get sick after June first, 
because after June first, there is no more contract health money. And 
if you get sick after June first and show up at a hospital, and your 
problem is not ``life or limb,'' then you're not going to be treated, 
you're not going to be paid for.

[[Page S11579]]

  So let me describe some of these things.
  An 80-year-old American Indian elder, a diabetic, living on an Indian 
reservation, fell while tending to her garden, and she broke her leg in 
two places. The break was so severe there was a bone sticking out of 
her ankle. She went to the hospital. She was sent home with 
painkillers. She went to a second hospital and was told the condition 
was not priority 1--not priority 1: which is ``life or limb''--and 
therefore she was not able to get care at the second hospital. She went 
to the third hospital--limped in--and finally received some care at the 
third hospital, with a bone protruding from her leg.
  Now, what is ``life or limb''? That is under what is called contract 
care. It means that if your life is not at stake, or the loss of an arm 
or leg is not at stake, you do not get the contract care. So don't get 
sick after June.
  Another American Indian with diabetes called in for a prescription 
drug refill for insulin, and he was told he needed to come back in and 
get some blood work done before he could get the insulin. It was 2 
weeks before they could get him in for his blood work, so he was 
without insulin for 2 full weeks. As a result, this is an American 
Indian who will likely require dialysis for the rest of his life 
because he could not get his prescription for insulin filled on time.
  Or a woman named Lida Bearstail. Lida told me it was all right to use 
her name. She went to a clinic because of knee pain. Her condition was 
one in which the cartilage had worn away, so it was bone on bone, 
enormously painful for Lida. Bones in her knee were rubbing against 
each other with great discomfort and great personal pain.
  When that happens to one of us, to our families, to the people who 
work here, what is the response? You get a knee replacement--surgery, 
and replace the knee.
  Well, what happened to Lida Bearstail? Well, she still limps. She has 
trouble walking. Perhaps soon she will not be able to walk. Knee 
surgery is not in her future because this is not about ``life or 
limb,'' it is just about unbearable, agonizing pain. Again, denied, not 
a priority, not ``life or limb.''
  Ardel Hale Baker told me I could use her story as well. A couple of 
months ago she had very serious chest pain and she thought she was 
perhaps having a heart attack. Her blood pressure was very high. Her 
chest pain was very intense. It wouldn't quit. So she went to the 
Indian Health Service clinic. She was diagnosed as having a heart 
attack, and she needed to be sent immediately to the nearest major 
hospital. And they said: You have to go in an ambulance.
  Well, Ardel Hale Baker said, while she was having this heart attack: 
Is there a chance I could go to the hospital in something other than an 
ambulance, some method other than taking an ambulance?
  They asked her: Why?
  She said: Well, I'm going to get billed for the ambulance, and I 
don't have any money.
  If you are not ``priority 1,'' you may end up paying the bill. Your 
credit rating is ruined. American Indian after American Indian 
discovers that: You are not a priority. Your credit rating is gone. And 
the credit companies come after you.
  In the middle of her heart attack, she asked the question: Is there 
some other method besides an ambulance? Why? Because of cost.
  Anyway, she arrived at the hospital. And let me tell you what 
happened at the hospital with Ardel Hale Baker. The nursing staff was 
lifting her off the gurney from the ambulance and putting her on a 
hospital bed, and as they lifted her off the gurney, they found 
something taped to her leg. This woman was having a heart attack, and 
they found a piece of paper taped to her leg. And here is what the 
paper said. It said her name: ``Hale, Ardel.''
  And then it said:

       You have received outpatient medical services. This letter 
     is to inform you your priority 1 care cannot be paid for due 
     to funding issues.

  So a woman is hauled into a hospital on a gurney with a heart attack 
and a paper attached to her leg saying: ``This will not be paid for.'' 
This kind of thing is unbelievable, and it is going on in this country 
with respect to American Indians for whom we have a trust 
responsibility for health care, and those needs are not being met.
  As I indicated, Senator McCain and I have worked long and hard on 
this legislation, only to find roadblocks every--every--part of the 
way. The Health and Human Services agency, the Justice Department, 
virtually every agency continues to raise roadblocks even today.
  I have come to the floor many times in this session of the Congress 
to talk about a young girl named Avis Littlewind. She is also a part of 
this legislation. Avis Littlewind was 14 years old when she killed 
herself. It does not sound good to say that. That is what happened to 
her. She laid 90 days in a bed in a fetal position, missing school, 
severely depressed. Then she took her life.
  Avis Littlewind was a teenager, 14 years old, who apparently felt 
things were so hopeless, she was so helpless, that she should take her 
life. Her sister had taken her life 2 years prior.
  Now, I went to that reservation. I met with the tribal chairman, I 
met with the tribal council, I met with Avis's schoolmates, I met with 
the relatives, to try to understand what causes this. And it is not 
just Avis Littlewind. It is not just this young girl. There has been a 
cluster of suicides, teenage suicides, on these reservations, and none 
of us really want to talk about it. But if we don't, we will not be 
able to address it.
  Senator McCain and I held some hearings on this subject. The Indian 
Health Care Improvement Act begins to address this, as it is addressed 
in some other legislation that we have moved as well.
  But my point is this, there are so many challenges. Do you want to go 
to a place where you can find 5,000 people and one dentist working in a 
trailer house? Do you want to see that sort of thing? Do you want to go 
to health clinics that are not open at key times during the day, and 
long lines when they are open? Do you want to go to places where the 
rate of diabetes is not double, triple, quadruple, but 12 times the 
national average, and see the people who have lost their legs as a 
result of diabetes, see the people on renal dialysis? Do you want to 
talk to the people who drive 50, 100 miles or more to get renal 
dialysis?
  The fact is, we have a bona fide crisis in health care on Indian 
reservations. We are not meeting that crisis. We have legislation that 
should have been passed in previous Congresses. Senator McCain and I 
have done everything humanly possible to get a piece of legislation 
that would get cleared to pass this Congress, and I regret to tell you, 
despite all the good feelings on the floor of the Senate about what is 
being done, frankly, I think it is a disgrace that this legislation is 
not being done.
  People are dying. There are young children who are not getting health 
care who are sick and need health care. There are elders with bones 
sticking out of their legs who are told health care is not available to 
them. There are women showing up on gurneys in hospitals with paper 
taped to their legs saying: ``This woman is not eligible for funding 
for health care.''
  That ought to shame every American that it is happening. And we can 
do something about it by passing legislation called the Indian Health 
Care Improvement Act. We are not asking for everything here. We are 
just asking for the right thing.
  Senator McCain and I have worked for a long while, and if I sound 
frustrated, it is because this is not just some other piece of 
legislation. This will mean that some people will die because we have 
not fixed the health care system, and we have not addressed these 
needs. We should not have to be reminded of this. It is our 
responsibility. This trust responsibility for the health care for 
Native Americans belongs to us, and we ought not have to be expected to 
be reminded of it. We ought to come to the floor of the Senate and 
insist on it. Instead, month after month after month, we have had 
objections, yes, in this Congress, I should say. We have had holds on 
the legislation. We have had committees that have insisted they could 
not move on it. We have had agencies downtown. And for dozens of 
reasons, we now come to the last day of the U.S. Congress in this 
session, and no action, and no capability, it appears to be, of making 
progress. And I am deeply disappointed.

[[Page S11580]]

  I will, of course, not give up. We will be back in January. We will 
start again. But this is deeply disappointing to me and to others who 
have relied on the good will of not just those in Congress but those 
downtown in the Federal agencies to understand there is a crisis. This 
is about health care. It is about ``life and limb.'' And when you have 
this kind of crisis, you have a responsibility to the children, to the 
elders, to others living on Indian reservations, some of whom live in 
Third World conditions. We should not be putting up with that. We 
should reach out a hand to say there is a lot of trouble in the world--
and we reach out a hand to try to see if we can help in other parts of 
the world--there is plenty to do right here at home as well. I support 
reaching out to troubled spots of this world. But I believe we also 
have a first responsibility to reach out in this country to say to 
people who are living in abject and desperate poverty without health 
care that we are going to solve those problems, we are going to work 
with them.
  I got interested in and involved in these issues a long time ago when 
I saw a picture in a paper of a young girl named Tamara. Tamara was a 
3-year-old American Indian girl living on an Indian reservation, and 
she was placed in a foster care home. The woman who placed her in the 
foster care home was handling 150 cases--150 cases. She did not have 
the time or the capability to check what kind of home they were putting 
this 3-year-old girl in. The result was, they put that girl in an 
unsafe home.
  On a Saturday night, in a drunken party, a 3-year-old girl named 
Tamara had her nose broken, her arm broken, and her hair pulled out by 
the roots--at a drunken party in a foster home that no one had checked. 
This 3-year-old girl suffered scars that will be with her the rest of 
her life.
  The fact is, we understand that some of these things are happening, 
and we have a responsibility to do something about it. I did something 
about that. There is nobody on that reservation handling that many 
cases anymore. No social worker can do that. What that child suffered 
was our responsibility.
  So I got involved because I saw what was going on some long while 
ago. And the more I have worked on these issues, the greater I see the 
need for us to do the right thing. Senator McCain feels exactly the 
same way, and we have worked as hard as we can work on a bipartisan 
basis in the Indian Affairs Committee, with the Republicans and 
Democrats on that committee, believing that health care is a priority, 
and that our responsibility to reauthorize the Indian Health Care 
Improvement Act is a primary responsibility.
  And, again, I regret that we come to the last day of the session and 
find a circumstance where it is not going to be passed.
  It takes no skill to oppose. I think it was Mark Twain who was once 
asked if he would engage in a debate, and he said: Of course, I would 
be happy to engage in the debate, as long as I can take the opposing 
view.
  They said: We haven't told you the subject of the debate.
  He said: It doesn't matter what the subject is. Taking the opposing 
view will require no preparation.
  That is how it is in this Chamber. It is how it is downtown in the 
agencies. It is the easiest thing in the world to oppose. It takes no 
preparation at all.
  We come to the end of this session with enough having opposed 
progress on the Indian Health Care Improvement Act that this will not 
be done in this session of Congress. There will still be hope because 
we will turn to it again in January. My hope is those who have borne 
the responsibility of stopping this important piece of legislation will 
understand the consequences and decide to help us rather than hinder us 
as we try again in the next session of Congress.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DeMINT. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Isakson). Without objection, it is so 
ordered.

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