Indian Healthcare Improvement Act

IHS Affirmative
Observation One: Inherency 2
Advantage One: Health 5
Advantage Two: Indigenous Economy 9
Observation Two: Solvency 14
Only federal action can solve the case- denying Indian health care furthers an ongoing policy of
American Indian genocide 17
Inherency Lack of Funding 18
Inherency Lack of Funding 19
Inherency Lack of Funding 20
Inherency Lack of Funding 21
Health Impacts Disease/Death 22
Health Impacts Disease/Death 23
Health Impacts Disease/Death 24
IMPACT: Mental Health and Suicide 25
IMPACT: Mental Health and Suicide 26
Extensions to Genocide/Racism Impact 27
Extensions to Genocide/Racism Impact 28
IMPACT: Moral Obligation/Human Rights 29
Solvency Extension - IHCIA/IHS Solves 30
Solvency Extension - IHCIA/IHS Solves 31

Solvency Extension - IHCIA/IHS Solves 32

Solvency Extension - IHCIA/IHS Solves 33
Solvency Extension - IHCIA/IHS Solves for cultural sensitive health 34
Solvency Extension Congress Key 35
Solvency Extension Federal Government Key 36
A2: I.H.S. is Racist 37
A2: Transportation 38
A2: Structural/Distribution Barriers 39
A2: No Qualified Professionals 40
A2: Bureaucrats 41
A2: IHS has arbitrary eligibility standards 42
A2: Blood Quantum 43
A2: Medicaid Solves 44
AT: Medicaid Solves 45
AT: Medicaid Solves 46
A2: IHS doesnt use traditional medicine 47
Tribal Economy Extension 48
Tribal Economy Extension 49
Tribal Economy Extension 50
A2: Casinos Solve Tribal Economies 51
Tribal Economy Extension Waste 52
Nuclear Waste = Genocide Extension 53

Nuclear Waste = Genocide Extension 54

Nuclear Waste = Genocide Extension 55
Nuclear Waste leads to Extinction Extension 56
Nuclear Waste leads to Extinction Extension 57
Observation One: Inherency
1. The Indian Heal Service (IHS) is the federal health care program designed to provide free health
care for Native Americans in the United States. Unfortunately this program is woefully under funded.
CLEVENGER Sep 14, 2009 (SAMUEL, Governments disservice to Indians is unrelated to health
care debate, http://www. cantonrep.com/opinion/letters/x244359597/Government-s-disservice-toIndians-is-unrelated-to-health-care-debate)
The horror stories of clinics and hospitals on Native American reservations are true and prevalent.
The IHS is a grossly underfunded, under-resourced, poorly managed government-run health care
system. But the reason is not that the federal government is inherently incapable of running a health
care system, but that the government has never provided adequate support and care for Native
Americans. On average, while the United States spends more than $6,000 per capita on health care,
only $2,100 is spent on IHS funding. Native Americans have lower life expectancy as well as higher
rates of HIV/AIDS and diabetes, among other terrible diseases. The list of atrocities the U.S.
government has committed against Native Americans is long and exhaustive. The current state of
the Indian Health Service has no bearing on the capability of the U.S. government to run a health
care system. Its just a reminder of how the U.S. government still does inadequately support Native
Americans.
2. Even though the stimulus act increased the IHS budget by 13% it still is only half of what is
needed to meet out obligation to Native Americans.
Associated Press, Jul 10 2009 3:16 PM [Diabetes concern at Colo.'s American Indian summit]
(http://www.examiner.com/a2112192~Diabetes_concern_at_Colo__s_American_Indian_summit.html)
"I think people are excited about this and interested about the ways to improve Indian health," she
said, adding that the nearly 13 percent increase in IHS funding approved by President Barack
Obama is a start to improving health care in Indian Country. "We really need more resources in the
Indian Health Service to effectively meet our mission, but also, just getting more resources isn't

going to solve all our problems." The IHS was appropriated nearly $3.6 billion this year, about half of
what it needs, the agency said. Roubideax said Indian Country could be used as a model for the rest
of the nation on how to combat these tough health issues not only affecting American Indians, but
the entire nation. "Take the epidemic of diabetes, it hit this population 20 to 30 years prior to the
rest," she said. "As a result we've had more time to address the problems. I definitely think the rest
of the country can learn from the lessons that we've learned in the Indian Health Service." The
federal government accepts a double standard. Any discussion about rationing or government care
is off the table unless youre 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 an obligation to the United States). 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 NCAI, fixing this problem would add
$40 million a year to the budget.
Plan: The United States Federal Government should reauthorize the Indian Health Care
Improvement Act of 1976 and provide an increase in discretionary funding for the federal Indian
Health Service, including funds for culturally-specific health care programs and Indian Health Service
affiliated services provided through both on and off-reservation health service programs.
Advantage One: Health
1. The result of IHS under funding is that American Indians receive the worst health care of any US
population death rates from preventable causes are skyrocketing. Even prisoners receive twice as
much health care funding.
Warne 2008, President and CEO of American Indian Health Management & Policy, (Donald, Indian
Country Today, Indian Health a legal right, 6/13/08, http://www.indiancountrytoday.com/archive /
28397974.html, Accessed 6/28/09, CAF)
The media recently shined a spotlight on life expectancy rates in the United States. One obvious but
unstated element in most news stories is that longevity correlates with health status, which directly
correlates with economic status. American Indians suffer alarming gaps in life expectancy. Death
rates from preventable causes like diabetes, alcoholism and mental illness are dramatically higher
among American Indians than the rest of the population. Nearly one-third of our people live in
poverty, compared to approximately 12 percent of the rest of the country. In Arizona, where I live, the
average age at death is 72.2 years for the general population and 54.7 years for American Indians.
Even people in Bangladesh and Ghana live longer. Despite this gross inequality, American Indians
are the only population born with a legal right to health care in this country.The treaties between the

tribal nations and the federal government - involving exchanges of vast amounts of Indian land and
natural resources - resulted in federal guarantees for social services including housing, education
and health care. The BIA and IHS were established to administer the federal government;s trust
responsibility to provide health care and other vital services to American Indians. In the 2005 federal
budget, per capita expenditures for IHS were $2,130, a fraction of the federal funding for other health
care programs like Medicare ($7,631), Veterans Administration ($5,234) and Medicaid ($5,010).
Even the Bureau of Prisons allocation is higher, at $3,985.So what would it take to fix the funding
shortfalls in the IHS budget? The number of American Indians actively using IHS services is about
1.5 million, and clinical services for the IHS are funded at approximately $3 billion per year. Several
studies have shown that the IHS is funded at approximately 60 percent of need.
2. Without treatment, diabetes alone will cause American Indian extinction.
Couto and Eken 2002 (Richard & Stephanie, Professor of Leadership Studies at Antioch College and
Stephanie C. Eken, Adolescent Psychiatry & Pediatric Psychiatry, To Give their Gifts: Health,
Community, and Democracy, p. 28-29).
Diabetes afflicts Native Americans at an alarming rate. Twenty-six out of every 1,000 people in the
United States had diabetes in 1987. The United States Public Health Service hoped to lower this
incidences to 25 per 1,000 by the year 200. However, the rate of diabetes actually increased to 31
per 1,000 by 1996. The rate among Native Americans served by IHS increased from 69 to 90 cases
per 1,000 during the same period. This conservative estimate is almost three times the
corresponding rate of the general population (Public Health Service 2001b:245; 1999). Diabetes
occurred in epidemic portions in the Rosebud community, yet the community remained far too
complacent in DeCoras view, as the disease killed relatives and friends: I didnt know whether or not
Indian people even knew that they were in the midst of an epidemic, despite the fact that probably
everybody had at least one relative or friend that had diabetes or they had it themselves. I worked in
IHS, living in this comfort zone; inside I was dying because I didnt feel like I was using my potential
to really make some long-term positive change[in] our peoples health. I felt like my time in IHS
was spent applying Band-Aids and really not getting to the root problem of the disease. I believed
then, as I believe not, that if we dont come up with creative ways to combat this diseases, were
going to be extinct as a people by the middle of the next century. With the time I have left, I need to
be working on the way I believe this disease should be approached amongst our people and that is
through our culture. The answer to this disease and other disease, including social ills, lie in our
tradition.
3. Denying Indian health care furthers an ongoing policy of American Indian genocide
Valentine, PhD Candidate, Sociology, Texas A&M, 08

(Shari, The Genocide that Never Ends: Bush to Veto Indian Health Services Bill, Racism Review,
http://www.racismreview.com/blog/2008/02/03/the-genocide-that-never-ends-bush-to-veto-indianhealth-services-bill/)
The headline on the New York Times Editorial on January 28 reads Vetoing Historys
Responsibility. The story unfortunately is not about history, but the entirely too current engagements
in the 400 year old American Holocaust against American Indians. The latest strategic strike is a
Presidential Veto of Indian Health Services Legislation. Heres the opening paragraph from the
NYTimes editorial: President Bushs threat to veto a bill intended to improve health care for the
nations American Indians is both cruel and grossly unfair. Five years ago, the United States
Commission on Civil Rights examined the governments centuries-old treaty obligations for the
welfare of Native Americans and found Washington spending 50 percent less per capita on their
health care than is devoted to felons in prison and the poor on Medicaid. The NYTimes piece goes
on to make note the fact that: Studies have established that Native Americans suffer worse than
average rates of depression, diabetes and cardiovascular disease. The Senate bill would improve
treatment for these problems, as well as address alcohol and substance abuse, and suicide among
Indian youth. It would expand scholarship help so more American Indians could pursue careers in
health care. Actually according to Indian Health Service and the National Center for Health Statistics
worse than average is a gross understatement. American Indians have:
Infant mortality rate 300% higher than the national average
Tuberculosis rates 500% higher than the national average
Diabetes 200% higher than the national average
Cervical Cancer 170% higher than the national average
Maternal death in childbirth 140% higher than the national average
Influenza and pneumonia 150% higher than the national average
Teenage suicide rates 150% higher than the national average
Overall suicide rates 60% higher than the national average
These rates have increased over the rates reported by the IHS in 1996. Only diabetes has declined
and that only slightly. These are diseases that are highly preventable and treatable, unless you are a
Native American held hostage to a centuries old policy of genocide. Native American health
expenditures are half as much as that spent on prisoners and Medicaid patients and we are all too

familiar with the intolerable health care provided to those groups. Federal appropriations are the only
source of health care funds available to Native Americans. Outside philanthropy is bureaucratically
prohibited. Some years ago I worked with an organization that donates medical equipment and
supplies to underserved populations. A retiring doctor wanted to donate cutting edge mammogram,
catscan and MRI machines as well as some other equipment to serve Native Americans. A national
corporation agreed to transport the equipment free of charge and a medical supply company agreed
to set it up and service it. The appraised value of the equipment was over 3 million dollars. For
months working with then Senator Ben Nighthorse Campbell, we waded through red tape and forms
to get permission for the equipment. In the end, the equipment was sent abroad because the Bureau
of Indian Affairs would not approve the $575 necessary to build a pad for the MRI machine and $700
to upgrade a room for the catscan. When we raised the money to pay for these items, we were told
that the individual clinics could not accept contributions and the BIA would need more than 9 months
to process the contributions and could not guarantee expenditure of the funds on the purpose for
which we were raising them. In spite of the investigation and recommendation of the Civil Rights
Commission the President will continue this long tradition. Native Americans have only the Indian
Health Service. No amount of public concern or private philanthropy can even be offered to mitigate
the health effects of the governments centuries of racist policy. The American public likes to think
that tactics like giving smallpox infested blankets to native people are history. The centuries old
oppression and systematic extermination of Native Americans continues and remains invisible to
most Americans. In Germany, Turkey, Sudan, we call that genocide.
4. Genocide causes war and extinction.
Kenneth J Campbell, Professor of Political Science & International Relations at the University of
Delaware, '01
(Genocide and the Global Village, p. 15-6)
Regardless of where or on how small a scale it begins, the crime of genocide is the complete
ideological repudiation of, and a direct murderous assault upon. the prevailing liberal international
order. Genocide is fundamentally incompatible with, and destructive of, an open, tolerant.
democratic, free market international order. As genocide scholar Herbert Hirsch has explained. The
unwillingness of the world community to take action to end genocide and political massacres is not
only immoral but also impractical [W]ithout some semblance of stability, commerce, travel, and
the international and intranational interchange of goods and information are subjected to severe
disruptions.3 Where genocide is permitted to proliferate, the liberal international order cannot long
survive. No group will be safe: every group will wonder when they will be next. Left unchecked,
genocide threat-ens to destroy whatever security, democracy, and prosperity exists in the present

international system. As Roger Smith notes :

Even the most powerful nations - those armed with

nuclear weapons may end up in struggles that will lead (accidentally, intentionally. insanely) to the
ultimate genocide in which they destroy not only each other. but mankind itself, sewing the fate of
the earth forever with a final genocidal effort.4 In this sense, genocide is a grave threat to the very
fabric of the international system and must be stopped, even at some risk to lives and treasure.
4. Inaction is tantamount to genocide denial and results in extinction.
Lilian Friedberg. 2001. Doctoral Candidate in German Studies at University of Illinois.
http://muse.jhu.edu/ journals/american_indian_quarterly/v024/24.3friedberg.html
Most importantly, perhaps, what distinguishes the American Holocaust from the Nazi Holocaust is
what is at stake today. The Nazi Holocaust represents a historical event that threatened the entire
Jewish population of Europe. Relegating this event to the archive of oblivion would involve a fatal
miscalculation resulting in wholesale moral bankruptcy for the entire Western world. But the
worldwide Jewish population can hardly be said to be at risk of extermination today--certainly not in
the United States. American Jews stepped up their efforts to direct attention to the Nazi Holocaust at
a time when they were by far the wealthiest, best-educated, most influential, in-every-way-mostsuccessful group in American society--a group that, compared to most other identifiable minority
groups, suffered no measurable discrimination and no disadvantages on account of that minority
status. 48 Norman Finkelstein cites the Jewish income in the United States at double that of nonJews and points out that sixteen of the forty wealthiest Americans are Jews, as are 40 percent of
Nobel prizewinners in science and economics, 20 percent of professors at major universities and 40
percent of partners in law firms in New York and Washington. 49 Native Americans, by contrast,
have long been subject to the most extreme poverty of any sector in the present North American
population, and still have the highest rate of suicide of any other ethnic group on the continent. 50
High-school [End Page 365] dropout rates are as high as 70 percent in some communities. As
Anishinabeg activist and Harvard-educated scholar Winona LaDuke notes with regard to the Lakota
population in South Dakota: "Alcoholism, unemployment, suicide, accidental death and homicide
rates are still well above the national average." 51 Alcoholism, intergenerational posttraumatic
stress, and a spate of social and economic ills continue to plague these communities in the
aftermath of the American Holocaust. This is not to deny or diminish the clear and present danger in
the ominous resurgence of anti-Semitic sentiments reflected in isolated incidences of racial violence
against Jews and Jewish institutions both here and abroad. However, the material realities
confronting the Native American population remain, in many instances, comparable to those
prevailing in Third World countries. The Native American experience of persecution is not a vicarious
one. For substantial portions of this population, it is a lived reality. What is more, an unrelenting
sentiment of Indian-hating persists in this country: There is a peculiar kind of hatred in the

northwoods, a hatred born of the guilt of privilege, a hatred born of living with three generations of
complicity in the theft of lives and lands. What is worse is that each day, those who hold this position
of privilege must come face to face with those whom they have dispossessed. To others who
rightfully should share in the complicity and the guilt, Indians are far away and long ago. But in
reservation border towns, Indians [End Page 366] are ever present. . . . The poverty of
dispossession is almost overwhelming. So is the poverty of complicity and guilt. In America, poverty
is relative, but it still causes shame. That shame, combined with guilt and a feeling of powerlessness,
creates an atmosphere in which hatred buds, blossoms, and flourishes. The hatred passes from
father to son and from mother to daughter. Each generation feels the hatred and it penetrates
deeper to justify a myth. 54 Attempts on the part of American Indians to transcend chronic,
intergenerational maladies introduced by the settler population (for example, in the highly contested
Casino industry, in the ongoing battles over tribal sovereignty, and so on) are challenged tooth and
nail by the U.S. government and its "ordinary" people. Flexibility in transcending these conditions
has been greatly curtailed by federal policies that have "legally" supplanted our traditional forms of
governance, outlawed our languages and spirituality, manipulated our numbers and identity, usurped
our cultural integrity, viciously repressed the leaders of our efforts to regain self-determination, and
systematically miseducated the bulk of our youth to believe that this is, if not just, at least inevitable."
55 Today's state of affairs in America, both with regard to public memory and national identity,
represents a flawless mirror image of the situation in Germany vis--vis Jews and other non-Aryan
victims of the Nazi regime. 56 Collective indifference to these conditions on the part of both white
and black America is a poor reflection on the nation's character. This collective refusal to
acknowledge the genocide further exacerbates the aftermath in Native communities and hinders the
recovery process. This, too, sets the American situation apart from the German-Jewish situation:
Holocaust denial is seen by most of the world as an affront to the victims of the Nazi regime. In
America, the situation is the reverse: victims seeking recovery are seen as assaulting American
ideals. But what is at stake today, at the dawn of a new millennium, is not the culture, tradition, and
survival of one population on one continent on either side of the Atlantic. What is at stake is the very
future of the human species. LaDuke, in her most recent work, contextualizes the issues from a
contemporary perspective: Our experience of survival and resistance is shared with many others.
But it is not only about Native people. . . . In the final analysis, the survival of Native America is
fundamentally about the collective survival of all human beings. The question of who gets to
determine the destiny of the land, and of the people who live on it--those with the money or those
who pray on the land--is a question that is alive throughout society. 57 [End Page 367] "There is," as
LaDuke reminds us, "a direct relationship between the loss of cultural diversity and the loss of
biodiversity. Wherever Indigenous peoples still remain, there is also a corresponding enclave of
biodiversity." 58 But, she continues, The last 150 years have seen a great holocaust. There have
been more species lost in the past 150 years than since the Ice Age. (During the same time,

Indigenous peoples have been disappearing from the face of the earth. Over 2,000 nations of
Indigenous peoples have gone extinct in the western hemisphere and one nation disappears from
the Amazon rainforest every year.) 59 It is not about "us" as indigenous peoples--it is about "us" as a
human species. We are all related. At issue is no longer the "Jewish question" or the "Indian
problem." We must speak today in terms of the "human problem." And it is this "problem" for which
not a "final," but a sustainable, viable solution must be found--because it is no longer a matter of
"serial genocide," it has become one of collective suicide. As Terrence Des Pres put it, in The
Survivor: "At the heart of our problems is that nihilism which was all along the destiny of Western
culture: a nihilism either unacknowledged even as the bombs fell or else, as with Hitler or Stalin,
demonically proclaimed as the new salvation." 60
Advantage Two: Indigenous Economy
1. Poor health care creates systematic cycles of economic depression and federal dependence
IHS funding is necessary to improve social and economic development
Barry et. Al., Chairwoman of the U.S. Commission of Human Rights, 2004
(Mary, U.S. Commission on Human Rights, Broken Promises: Evaluating the Native American
Health Care System, September. Pages 7-8, MAG)
Consequently, not only is reduced health status a burden to Native Americans, but a cumulative
drain on the entire Native American existence. Poor health inhibits the economic, educational, and
social development of Native Americans and establishes an inescapable cycle of disparity.
Nevertheless, not all news regarding health status is bad news. The IHS, which has been given
primary responsibility for eliminating this disproportionate health status, has been largely successful
in reducing mortality rates, while making significant improvements in other areas.5 Dr. Perez
explained that the incidence and prevalence of many infectious diseases have been dramatically
reduced through increased clinical care and public health efforts such as vaccination for infectious
diseases and the construction of sanitation facilities. Today, Native Americans continue to experience
significant rates of diabetes, mental health disorders, cardiovascular disease, pneumonia, influenza,
and injuries. Specifically, Native Americans are 770 percent more likely to die from alcoholism, 650
percent more likely to die from tuberculosis, 420 percent more likely to die from diabetes, 280
percent more likely to die from accidents, and 52 percent more likely to die from pneumonia or
influenza than the rest of the United States, including white and minority populations.7 As a result of
these increased mortality rates, the life expectancy for Native Americans is 71 years of age, nearly
five years less than the rest of the U.S. population.8 A comparison of earlier life expectancy data
illustrates one of the problems facing IHS in eliminating disparities. In 1976, the life expectancy for
Native Americans was 65.1 years, compared with 70.8 years for other Americans.9 Consequently,

while life expectancy for Native Americans has improved by six years, the difference in life
expectancy relative to other Americans has changed very little. Another problem facing health care
providers is the increasing importance of the behavioral component of health status. During the
October briefing, Dr. Perez explained that fully seven of the top 10 causes of high morbidity and
mortality rates are directly related to, or significantly affected by individual behavior and lifestyle
choices.
2. Poverty dehumanizes its victims