The following is the text of a floor speech by Senator Tom Daschle (D-S.D.) on an amendment to increase the budget for the Indian Health Service. March 11, 2004.

Mr. President, last week's Congress Daily included a story that still troubles me deeply and gets at the heart of why I am offering this amendment.

HHS Secretary Tommy Thompson, in response to a question about why the Bush administration is providing funding for universal health care in Iraq, but not in America, replied:

Even if you don't have health insurance in America, you get taken care of. That could be defined as universal health care.

I don't think Secretary Thompson is callous, so he must be desperately out of touch. Either way, it's shocking to hear the nation's top health care official claim that America has universal health care.

More than 43 million Americans are uninsured. According to the National Institute of Medicine, uninsured Americans who access emergency rooms or free clinics get about half the medical care of those with health insurance--they live sicker and die sooner than those with insurance. Approximately 18,000 Americans die unnecessarily each year because of lack of health care. And the problem isn't just uninsured Americans. Millions more Americans are under-insured.

There are 2.5 million Native Americans in this country who--theoretically--have insurance. All too often, they get abysmal health care--or none at all. America is obligated--by law and by treaty--to provide free health care for American Indians--a commitment we made to Indian people when the U.S. Government took their lands. America is not honoring that commitment. Native Americans suffer higher rates of many serious illnesses--including diabetes, heart disease, and Sudden Infant Death Syndrome--than the rest of the population. Yet Indian Health Service funding is wholly inadequate.

The Indian Health Service makes up only one-half of one percent of the HHS budget. Its budget has consistently grown at a far slower rate than the rest of the HHS budget. That means that the health system with the sickest people and the greatest need gets the smallest increases. That just doesn't add up.

In per capita terms, the United States spends about $5000 per year on health care for the general U.S. population. Contrast that with what the Indian Health Service spends per capita on health services for Native American men, women, and children: about $1900 per year. To put that in further perspective, you should know that's one-half of what the Government spends per capita on Federal prisoners' health care--$3800. The U.S. Government spends twice as much on Federal prisoners' health care as it spends on Native Americans' health care.

The result: American Indians live sicker and die younger than every other ethnic group. This has created what the U.S. Commission on Civil Rights calls a ``quiet crisis.'' Care is rationed in Indian Country through the use of a literal ``life or limb'' test. In many cases, you are denied care, or care is delayed, unless you are at risk of immediate loss of your life or a limb.

Secretary Thompson should come to Indian Country to hear some of the stories I hear when I talk to people on the Cheyenne River Indian Reservation or in Pine Ridge or at the Sioux San Hospital in Rapid City. Secretary Thompson, there is no universal health care in Indian Country. Just ask anyone who lives there. Secretary Thompson should apologize to Native Americans for his comments. More than that, he should make a commitment to fight for the funds the Indian Health Service needs to meet its obligations.

Democrats tried repeatedly last year to persuade our colleagues to fully fund at least one part of the Indian Health Service budget: clinical services. They refused, repeatedly. Last year, several of my Republican colleagues came to the floor to say: ``You're right--the health care situation in Indian country is abysmal, and it's unfair. Indian people do deserve better, but we just can't afford it. We can afford tax cuts for the wealthy elite, and we can afford billions on Iraq, but we can't afford to give Native Americans the health care we've promised them.''

Mr. President, that is just not acceptable. My friends on the other side may be willing to offer that excuse, but I am not. And they can no longer claim that they ``didn't know'' how bad Indian Country's health care crisis truly is. So we are trying again this year. We are offering the Senate a chance to finally right this indefensible wrong.

Our amendment would create a reserve fund to allow a $3.44 billion increase in IHS clinical services. This is not enough to provide health care services to every eligible American Indian and Alaska Native. It would, however, provide sufficient funds to serve the current IHS user population--the people who currently depend on the Indian Health Service for their care.

The cost of this amendment, along with additional deficit reduction, is fully offset by eliminating abusive tax loopholes or reducing tax breaks for individuals with incomes over $1 million per year. And don't be fooled by promises made in a competing amendment to make unspecified cuts in domestic discretionary spending.

That amendment does nothing to raise the Appropriations Committee's budget allocation, and does nothing to put additional money in the IHS clinical services account. That funding isn't real, and those promises are empty. At best, it would rob Peter to pay Paul.

If America can afford to spend billions of dollars building hospitals and providing health care in Iraq, we can afford to honor our treaty obligation to provide health care for American Indians.

I realize we have obligations around the world. But we also have obligations here at home. Millions of Americans want to know, when is it their turn? When do we start paying attention to their needs? When do we take care of our own? We don't have universal health care in America, despite what Secretary Thompson thinks. And we certainly don't have universal health care in Indian Country. This amendment gives us the chance to offer Indian people the bare minimum of services that most of us take for granted and would consider essential. I hope we don't waste it.

I yield the floor.