[Congressional Record (Bound Edition), Volume 153 (2007), Part 2]
[Senate]
[Pages 1786-1787]
[From the U.S. Government Publishing Office, www.gpo.gov]




                  HEALTH CARE FOR THE FIRST AMERICANS

  Mr. DORGAN. Mr. President, I want for a moment this afternoon to talk 
about another issue that is of great importance to me and I think to a 
number of our colleagues here in the Senate as well. I am going to 
chair the Indian Affairs Committee in this session of Congress. I will 
be working with my colleague Senator Craig Thomas from the State of 
Wyoming. I am pleased to do that.
  I want to mention that this week my colleagues here in the Senate are 
likely to see members of Indian tribes who are coming to town from all 
over the country. They will likely see them here on Capitol Hill, 
perhaps in the halls of the Senate and the House. They are here to 
attend the ``State of Indian Nations'' address by the President of the 
National Congress of American Indians. They will come from across the 
country to hear this ``State of the Indian Nations'' address and they 
will probably also drop in some offices and meet with some Senators and 
Congressmen.
  Let me talk about one of the things I am sure they will talk about in 
virtually every office, and that is the issue of Indian health care. I 
have seen hearings where, talking about Indian health care, very 
powerful tribal leaders have been brought to tears when they talk about 
family members who have taken their own lives because of depression or 
drug abuse, or family members who needed medical attention desperately 
and did not get it.
  Let me talk a minute about the first Americans, those who were here 
first.

[[Page 1787]]

American Indians and Alaska Natives die at a higher rate than other 
Americans from tuberculosis. There is a 600-percent higher incidence of 
tuberculosis than the American population as a whole; alcoholism, 510 
percent higher than the population at a whole; diabetes, 189 percent 
higher than the American population as a whole. Let me say, in many 
areas it is quadruple, 8 times or 10 times higher than the population 
as a whole, in terms of the incidence of diabetes. Indian youth and 
teenage suicide on reservations in the northern Great Plains is 10 
times higher than the national average. There are fewer than 90 doctors 
for every 100,000 Indians compared to 230 doctors for every 100,000 
people nationwide. It is almost unbelievable to see what the Indian 
community faces with respect to the health care issues.
  The Indian Health Service expenditure for each American Indian in 
2005 was $2,130, compared to $3,900 that we spend for health care for 
Federal prisoners. We have a responsibility for the health care of 
Federal prisoners because we incarcerate them. If they get sick, it is 
our responsibility to provide for their health care. We have a trust 
responsibility for American Indians, and if they get sick--or in order 
to keep them well--it is our responsibility. Yet we spend almost twice 
as much money for health care for Federal prisoners as we do to meet 
our trust responsibility for American Indians.
  I hope my colleagues will have a chance to talk to some of the Indian 
leaders who come to the Capitol this particular week and visit about 
these issues.
  I want to show a picture of Ardel Hale Baker, to talk a little about 
what some people face. It is easy to talk about the statistics. Let me 
talk about the humanity of this issue. This is Ardel Hale Baker. She is 
a member of the Three Affiliated Tribes in my State. Ms. Baker had 
sudden and severe chest pains. Her blood pressure was off the charts 
and she felt she was having a heart attack. So she went to the Indian 
Health Service clinic of the Three Affiliated Tribes in New Town, ND, 
and she was diagnosed as having a heart attack. At the insistence of 
the Indian Health Service staff on that reservation, she was sent by 
ambulance to the nearest hospital, 80 miles away in Minot, ND. When she 
got to the hospital, Ardel was being lifted off of a gurney from the 
ambulance to be taken into the hospital, and the nurse noticed a piece 
of paper taped to her leg. Curious about this woman, with chest pains, 
likely having a heart attack--curious about what kind of piece of paper 
was taped to this woman's leg, the nurse looked and it was a letter. It 
was a letter from the Indian Health Service, warning that both Ms. 
Baker and the hospital should understand the Indian Health Service had 
no funds with which to pay for the health care she needed, because this 
was not considered a ``life or limb'' medical condition. Ms. Ardel Hale 
Baker later, after she survived, received a bill for $10,000.
  Let me recreate that again. This is a Native American, living on a 
reservation. She was having severe chest pains, clearly a heart attack, 
put in an ambulance and driven 80 miles, and when they pulled her out 
of the gurney to run her in to the hospital, they noticed a letter 
taped to her leg in which the Indian Health Service says: ``Understand, 
we don't have the money. Both Ms. Baker and the hospital should 
understand they may have to assume the cost because we don't have the 
money to pay for this. It is not life or limb.'' So this woman gets a 
bill for $10,000.
  Her life was saved, but it was saved notwithstanding a letter taped 
to her leg saying: ``Admit this woman at your own cost.''
  This is called rationing. It is called health care rationing. If 
health care rationing existed in this country, there would be an 
outrage, and it does exist and nobody says much. There is a quiet yawn; 
somewhere between daydreaming and thumbsucking. People sit around and 
hardly even think of the fact that when they are sick, it is OK because 
they can get health care. But when this woman is sick, she might get a 
letter taped to her leg saying: ``Yes, she is having a heart attack, 
but understand if you admit her, it is at your own expense.''
  An Indian tribal chief told us once that on his reservation everyone 
understood the admonition: ``Don't get sick after June.'' Do not get 
sick after June, because June is the time of the fiscal year when they 
run out of money for contract health care on the reservations. The 
Indian Health Service runs out of money after June. If you get sick 
after June, I am sorry, they might tape a letter to your leg. It is 
``life or limb.'' If your illness is not threatening your life or your 
limb, you are out of luck. That is rationing. That is health care 
rationing, and it is an outrage in this country. It is happening in a 
quiet way, inflicting misery all across this country on the first 
Americans, those who expect we would meet our trust responsibility to 
provide health care for Native Americans.
  We are going to try very hard to see if we can rectify that. I 
understand the Indian Health Service is staffed with some committed and 
wonderful doctors, nurses, and administrators. They are understaffed in 
a dramatic way, underfunded and understaffed. They tell us their budget 
allows them to treat about 60 percent of the health care needs of the 
Indian community. That means 40 percent is not dealt with.
  One of the things I would have us consider is a new model for 
delivery of health care, particularly on Indian reservations, that 
tracks what is happening in some other parts of the country where there 
are the kinds of low-cost, walk-in clinics open at all hours, where you 
can get the routine health care, routine diagnosis. I hope the Indian 
Health Service could do that at no charge. But what is happening now is 
not working at all. Often health care is not available.
  On one reservation of which I am aware, the clinic there is open 5 
days a week. After 4:30 or 5 o'clock on Friday: So long, tough luck. 
You are 80 miles from the nearest major city hospital, and if you get 
sick, that is where you are going to have to look for some health care. 
We need to do better than that. I hope we can succeed in talking to the 
Indian Health Service about a new model, a new approach.
  This is only one issue of many. We have a full-scale crisis, I 
believe, in Indian health care, Indian education, and Indian housing.
  I have spoken previously about a woman who died lying in bed in her 
house, who froze to death in this country. A woman named Swift Hawk 
froze to death when she lay down and went to bed, living in a climate 
with 35 degrees below zero weather with, instead of windows in their 
dwelling, plain plastic sheeting. This grandmother went to bed and 
didn't wake up because she froze to death. If you saw that in the 
paper, you would think it was a Third World country, but no, it is not. 
It is this country and it relates to a health care crisis we need to 
address. It is not about statistics. It is about the humanity of 
understanding what is happening and a responsibility to do something 
about it.
  I look forward to working with my colleague on the Indian Affairs 
Committee, Republicans and Democrats, who I think are of a like mind, 
that we have a responsibility here and we need to meet it, and we will.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Oklahoma.
  Mr. INHOFE. Mr. President, what is the regular order?
  The ACTING PRESIDENT pro tempore. The Senate is in morning business.
  Mr. INHOFE. I ask unanimous consent I be recognized for up to 25 
minutes in morning business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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