Mark Trahant: Duality in Indian health care
"One of the most difficult elements in the health care reform debate is the philosophical notion of “dualism.” In order to reach consensus we, as a nation, have to balance equally reasonable, yet competing ideas about how to expand coverage and control costs.

Indian Country has experienced duality in many forms – often described as a “love-hate” relationship with the federal government and its programs. An example of this would be the way Native Americans are the first to point out what’s wrong with the Indian Health Service or the Bureau of Indian Affairs, but on the other hand, if you really want an argument, try taking those programs away.

The same could be said for the men and women who wear the uniform of the National Health Service Corps. If you think about this country’s history – and the wars fought between American Indian tribes and the United States – it makes no sense at all for a military-like unit to provide health care services on reservations.

Yet this government agency may be the most effective (and the most quiet) provider of direct health care services. Indeed, while there’s debate in the Congress about the role of government in the health care arena, funding for the corps has already been expanded in a big way."

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