Enduring Legacies Native Case Studies

Case Study

The Indian health paradox: Honoring a treaty right or raising real dollars?

Author:Mark N. Trahant

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The United States has a legal and moral obligation to provide health care for American Indian and Alaska Natives. This is a responsibility that has been expressed through treaties, executive orders and federal law. The Indian health system began when the government sent doctors to reservations to inoculate against small pox. Over nearly two centuries, however, the system has evolved into a complex example of government-run health care. Make that two alternative systems: There are direct services delivered by the Indian Health Service. Many tribes say that even though that system is underfunded, it represents the United States fulfillment of treaty obligations. A second system is tribally or tribally-sponsored community health clinics that receive money from a variety of sources, including the Indian Health Service. Is the second system the wave of the future?

Updated: January 18, 2011