"A single phrase is often used to define the Indian health system: “Government-run.” Add those two words to any discussion about health care or reform and most people reach an immediate conclusion about the merits of the agency.

Now it is time for the phrase to disappear because it no longer accurately describes the Indian health system. After all, tribes or tribally authorized nonprofit agencies administer more than half of the IHS budget, through the Self-Determination Act or Self-Governance compacts.

Certainly the federal government plays a huge role in this health care delivery system – across the country. “As in all industrial nations, the U.S. government plays a large role in financing, organizing, overseeing, and, in some instances, even delivering health care,” said a report last August by the Robert Wood Johnson Foundation. How big are the numbers? Federal direct spending – Medicaid, Medicare & such – accounted for 33.7 percent of all health care spending. If you add in tribal, local, state and other government funding to the mix that figure reached $1.108 trillion – or about 46 percent of all health care dollars. The report said, “If tax subsidies that encourage provision of health coverage and health care are added in, the total public share comes close to three-fifths of all U.S. health spending.”

And all of these numbers are before the Patient Protection and Affordable Care Act was enacted into law and before any implementation."

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Government-run no longer describes the Indian health system (Mark Trahant 8/16)

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