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

"Health care reform (or any major policy shift) is one thing in Washington, D.C. But it’s always something else at the field level. How can government get it right in both locations?

One way is to make certain that top government leaders have some experience working at the delivery end of the system.

Consider the new director of the Indian Health Service: Dr. Yvette Roubideaux. She spoke at the Indian Health Summit here on July 7.

Roubideaux, who is Rosebud Sioux, last worked for the IHS as director of the San Carlos clinic. She said she knows what it’s like working in an environment where there are too few resources – and long lines of patients waiting for care. This experience taught her to be “creative” with what you have. Yet at her Arizona clinic, Roubideaux took pride in the sense that the medical care was better than at a comparable private institution. But after four years, in large part due to the limited resources, she said, “I was burned out. It’s difficult work. I needed a way to refresh and renew.”

That renewal took her to the University of Arizona’s College of Medicine Medical School and what Roubideaux describes as “a great life.” Her schedule was her own. She could invest time on research that she cared about – and research is critical because in the health care field dollars follow the data. That’s why she spent the last ten years working in academics, to help provide the data.

But that’s the question: What will it take for the government to appropriately fund its Indian Health agency? Roubideaux says there are “hopeful signs, so far.” The Obama administration takes pride in saying that its some $500 million is included in the stimulus package and a 2010 fiscal year increase of 13 percent for IHS funding is largest in 20 years. Perhaps that figure might be the most politically possible in this era of less."

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