Note: Follow Mark Trahant on Twitter. He is attending the Indian Health Service consultation in Denver, Colorado.

"The federal government accepts a double standard: Any discussion about rationing – or government care – is off the table unless you’re a member of an American Indian tribe or Alaskan Native community with a sort of pre-paid insurance program (many treaties, executive orders and laws were specific in making American Indian health care a United States’ obligation).

But the federal management of its health care network is full of inconsistencies, including the way the government pays itself. Medicare only reimburses IHS or tribal health facilities for 80 percent of the costs; so an already underfunded IHS essentially subsidizes Medicare. According to the National Congress of American Indians fixing this one problem would add $40 million a year to the budget.

This may sound odd, but I think with sufficient resources, the Indian Health Service could be the model for reform. The agency already knows how to control costs and the successful operation of a rural health care network. So much so that many rural non-Indian communities are looking for ways to tap into the system for the general population.

And while the funding scarcity results in substandard care, it’s not the only story. There has been considerable improvement in American Indian and Alaskan Native health since the IHS was founded. One study reported: “In the first 25 years of the program, infant mortality dropped by 82 percent, the maternal death rate dropped by 89 percent, the mortality rate from tuberculosis diminished by 96 percent, and deaths from diarrhea and dehydration fell by 93 percent. The improvement in Indians’ health status outpaced the health gains of other U.S. disadvantaged populations.”"

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The double standard of health care reform (Mark Trahant 7/6)