Misplaced Loyalties: Montana Native American Elected Leaders and Voters Silent in Health Care Debate

Native Americans in the state of Montana have much at stake in health care reform, yet, this pivotal and powerful swing vote has had scarcely anything to say on this issue. Montana is home to a 10 member Indian Democratic legislative caucus. Senator Baucus works closely with the Montana-Wyoming Tribal Leaders Council, based in Billings. The state's largest minority group has a unique and powerful voice to weigh in on the public option AND/OR single payer/universal; yet there is a stunning silence. (The exception is State OPI Superintendent, Denise Juneau who spoke to a pro-reform rally on Sept. 7 in Gt. Falls).

As a result of several years of federal neglect and lack of resources; Native Americans in Montana and elsewhere are moving away from their lands to the urban centers. Their health care does not necessarily follow them. Health care delivery by the Indian Health Service is largely reservation based, where nationally, only 30% of the tribal population is now located. Indian Health care is not portable, therefore, the I H S, rather than adjust to this new reality; simply provisions vans to shuttle those needing health care back to the reservation for a fuller slate of medical needs. Urban health clinics are sadly underfunded, understaffed and in some cases have no qualified staff to deliver even basic services. These urban clinics are limited to dispensing a handful of over the counter medications and minimal prevention activities.

The U.S. allocates more funding to its inmate population, per capita than it does to Native Americans. We have worse health care than a prison inmate. This stunning reality encompasses the daily reality of Native Americans; so used to the status quo that perhaps is the very reason for the silence. Native American voters who are apathetic toward politicians have accepted long ago that no matter how much they are engaged in the system; things will never change. There is a high degree of skepticism and dissatisfaction. Senator Baucus has in recent days only ingrained that perception. Native Americans were off his very limited schedule in August.

The Montana-Wyoming Tribal Leaders Council, a Baucus influenced group, has a two-faced approach to tribal sovereignty: on the one hand; it advocates banishment of certain language,

Remove I/T/U---"Indians, tribes, urbans, terminology and concept from any and all legislation and regulation. This concept has blurred and the status of federally recognized, large land base, large population tribes to which treaty rights and trust obligations flow. ....

according to its Health Care Reform resolution posted on its website. I agree treaties are the law of the land, they are extra-constitutional, valid legal obligations. Treaties should not be tools for political manipulation that result in tribes being less sovereign.

I do not agree with continued tribal mismanagement of precious resources, to the detriment of tribal people. It is tribal mismanagement perpetuated under 30 years of a Baucus regime which is resulting in Native Americans leaving their land based homes for more despair and hopelessness in urban areas. This is a revival of the 1830 Andrew Jackson Indian Removal era; Max Baucus style. Economic deprivation, substandard care and a pill epidemic have taken the place of forced marches by gun point. The group's position seems to emphasize that Native American people are voiceless unless it is spoken from a tribal elected official. This is not a democratic principle by any measure; unified voices are stronger.

This is the group that has enjoyed Baucus' ear for over 30 years in Montana; it is no longer a voice of the people, but sadly has become another tool in the Baucus arsenal. In this sense, it is even more disheartening to watch helplessly while Baucus extrapolates his political machinery on a national level and upon the American people in the health care matter. The hopeful and those seeking change may have thought Max Baucus was on their side because he claims Democratic party affiliation. Many were dismayed and downright disgusted as he slyly pulled single payer off the table early on. This is not surprising to his Native American critics, myself included. This is right out of his play book.

It should no longer be good enough that Native Americans feel grateful for being remembered; the federal impetus seems to be to continue forward with the I H S; and tweak it here and there to make it appear as a credible health care delivery system. It is time Native Americans demand more; quality and efficiency, a health care system that works for Native American families, youth, and elders. To be grateful that small pox blankets are no longer part of the annuity payments is not progress.

Maybe it is time for this powerful constituency to step up and seriously re-think its allegiance to Max Baucus and further; to ponder 30 years of failed policies that have not made their communities better off. Federal disinvestment on tribal lands occurred under his watch and it will only continue until this constituency takes to the streets and demands change. The onus is on this constituency to check this rogue Senator.

As more Native Americans ride the I H S shuttle to get their health care in Montana; back to tribal land where they can no longer afford to live, where there is inadequate, substandard and/or non-existent housing and what scant jobs that do exist barely pay a livable wage; we certainly have time to think it over on those long journeys. It is helpful to point out the World Health Organization in its 1986 Ottawa Charter for Health Promotion defines the fundamental conditions and resources for health

as peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. (WHO, 1999).

Our current system hopelessly fails that standard. Native Americans in Montana are not without hope: your senator chairs the Senate Finance Committee, the power to effect change for your families and communities is right in front of you. If he continues with his rogue mentality; remind him Montana has one of the lowest thresholds of voters needed (10%) to recall a public official. Force him to act in the best interests of his constituents, or enact a recall. If you allow the status quo to continue, you have only yourselves to blame.

This blogger is attempting to arrange a meeting with a Baucus staffer in the Senate Finance Committee who handles tribal appropriations matters later this week in Washington D.C. and will report on that meeting.