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What will the Indian health system look like?

Mark Trahant | Sep 02, 2010 02:00 AM

What will the Indian health system look like a decade from now?

That’s an impossible question to answer. There is the potential of a court ruling striking down at least part of the Patient Protection and Affordable Care Act. And, there is always the possibility of Congress will rewrite the law (I view this as remote because there would have to be a Super Majority to enact something else.)

But in the meantime there is a new foundation already under construction. The building that will rest on that structure will not be the same as the one in place now.

Let’s start with the patient. Right now, according to the Kaiser Family Foundation, [pdf] nearly half of all American Indians and Alaska Natives are either uninsured or rely solely on the Indian Health Service. But health care reform changes that. Big time. Beginning in four years, hundreds of thousands of people will become eligible for insurance through government programs (such as Medicaid) because of new income rules. This insurance can be used to pay for services at Indian health system facilities – or at competing health care centers. (Think about how many private walk-in clinics promise no waiting.)

Another huge change is that states have more at stake than ever in the success of the Indian health system. Let’s start with the premise that everyone who should be covered by these government insurance programs will be. (I know it’s a leap.)

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Enchanted with carbon caps

Bruce Frederick | Sep 01, 2010 02:00 AM

New Mexico is known for its stunning desert and mountain landscapes, vibrant mix of cultures and unique history. But this month the state is perched on the brink of becoming a leader in climate change regulation and plays a major role in moving the nation to a greener, stronger economy.

The New Mexico Environmental Improvement Board began hearings on an innovative proposal from New Energy Economy, an environmental non-profit. The proposal requires major carbon emitters, such as the oil and gas industry and electric utilities, to reduce emissions by 3 percent below a 2010 baseline each year. Unlike the confusing thousand-page cap and trade regulations under consideration at the federal level, and already in place in some states, our five-page proposal [PDF] focuses on immediately reducing emissions.

Initiating a carbon cap regulation in advance of any federal laws is a critical opportunity for not just New Mexico, but all western states. Sooner or later, whether through congressional action or through EPA Clean Air Act regulations, there will be rules restricting greenhouse gas emissions. States getting an early jump on emissions reductions may qualify for early reduction credits in these future policies. And setting the curve on innovative carbon reduction strategies will give New Mexico businesses a competitive edge. It will make our state a prime location for other states to purchase offsets for their own emissions. By regulating carbon now, we encourage New Mexico’s businesses to find the simple emissions reduction strategies -- like increasing energy efficiency -- while making long term plans for more substantial emissions reductions that will serve them well under future federal regulations.

Critically, climate science suggests that Western states, especially New Mexico, will face major consequences from global climate change. Less snow, earlier snow melt, bigger and more frequent flash floods, and summer droughts are all on the horizon. Climate change will also shift fragile mountain ecosystems to higher elevations, straining conditions for both wildlife and farmers. Between water shortages and shifting climatic patterns, New Mexico’s outdoor recreation and agricultural industries will face significant challenges.

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The role of higher education

John Freemuth | Aug 31, 2010 02:00 AM

Recently, the New York Times columnist David Brooks wrote “We should be able to….establish a set of concrete understandings about what government should and shouldn’t do. We should be able to have a grounded conversation based on principles 95 percent of Americans support.” Instead, as former congressman (and now Chairman of the National Endowment on the Humanities) Jim Leach has pointed out “it looks like increasingly people are lining up on one side or the other and they're, in effect, forming camps where the great American middle is at least proportionately very poorly represented in legislative bodies, particularly in Congress. “

Mr. Leach points us to an institution that might help us work ourselves out of this problem, but first we need to rethink that institution just a bit. That institution is the modern American university. As Leach notes: “I was told today, a university president was saying more students were lost at his university due to debt than bad grades. And that is one of the real challenges of our time: How we can afford a good university and public education at the post-secondary level?”

The simplistic answer is of course, by making a commitment to our universities. But we are in the throes of doing the opposite. I somewhat humorously, in my email signature line, refer to myself as a professor at Boise “State” University, because our funding from the state of Idaho is at 20% percent and declining. Public funding for other universities can be even lower. Where do we find the additional funding? What we do right now is chase huge research grants, like every other university. Those grants fall primarily in the area of what some call Big Science and Big Engineering.

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The Goliath of beets

Sightline | Aug 27, 2010 09:26 AM

By Michelle Venetucci Harvey

As of a recent court hearing, a multinational biotech company feels threatened, thousands of farmers in the Pacific Northwest see impeding doom, and half of the US sugar industry is potentially depleted. What could be causing all this ruckus? The sugar beet.

This month’s ruling by US District Judge Jeffrey White halts the use of genetically-modified (GM) sugar beet seeds until an environmental impact study (EIS) can be conducted. The GM crop is resistant to Roundup, a Monsanto-produced herbicide, which allows farmers to spray herbicides on their fields without damaging crops. (The ruling doesn’t impact sugar beet crops that have already been planted this season, but will potentially inhibit new plantings until at least 2012, when the study might be completed.) Sustainable food advocates are ecstatic while Monsanto is looking at a potential loss in the billions, but Pacific Northwest farmers are caught in the middle.

Introduced back in 2005, sugar beets had the fastest adoption rate of any GM crop in the United States; 95% of the sugar beets in the United States are now GM crops, and beet sugar accounts for half of the sugar in the country. Many sugar beet farmers are concentrated in Washington, Oregon, and Idaho, and almost all of the seed comes out of Willamette Valley in Oregon. Farmers are worried that there are no longer enough conventional seeds and herbicides in storage to replace all the GM seeds currently in use. It’s not a surprise that they are uneasy with the court decision, since they may struggle to sustain their crop yields without the GM sugar beets.

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The Amargosa

Seth Shteir | Aug 27, 2010 03:00 AM

The chef at Las Vegas’ Luxor hotel has a special recipe for dates:  pit them, stuff the sweet, succulent fruit with cheese, and wrap them in bacon. It’s a recipe that takes skill, planning, and a certain panache.

But what’s unique about this hors d’oeuvre isn’t just its sweet and savory flavor, but the fact that the dates come from China Ranch, a small date farm located on the Amargosa River in eastern California.  The ranch is run by Brian Brown, a date farmer whose passions extend beyond the culinary to include preserving the wild and scenic Amargosa- the only free flowing river in the Mojave Desert.  Brown is also a resource conservation advocate for the Amargosa Conservancy, a non-profit whose mission is to protect the river.

So what’s so special about a river that meanders through Nevada, trickles into California, and runs dry at a sandy lake bed -- called Badwater -- in Death Valley National Park, the lowest and hottest place in the United States? 

“The Amargosa is an Ice Age remnant,” explains Brown.  “There are perennial wet flows where animals and plants have adopted some very unique genetic abilities to cope with the hot, dry conditions.”

Animals that live in the Amargosa, like the desert pupfish that can survive extreme conditions, including warm oxygen-starved waters, are capable of adapting to new environmental conditions in a few generations.

Amargosa River

Amargosa River photo taken by David Lamfrom

But the pupfish aren’t the only organisms that thrive along the Amargosa River.  It’s also a critical migration stop for birds seeking juicy insects, shelter and nesting sites in the mesquite and willow bushes that line its banks.  Plants clinging to its banks and the rocky uplands prosper even among naturally occurring chemical and mineral loads that would stifle most species.  Brian Brown wonders if this kind of genetic ability could one day be put to human use.  Could we learn how to raise fish like tilapia in harsher conditions by studying desert pupfish or find crops that could be grown with minimal impact in an arid environment by learning about the ecology of desert plants?

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Educational benefits

Ed Quillen | Aug 26, 2010 04:30 AM

Some people love to travel, but I am not among them. I have the good fortune to live in a town that's just the right size. Salida, Colo., is small enough that I can walk to conduct most of my routine errands, and big enough for a supermarket, library, bookstore, pharmacy and the like. America's most popular whitewater river runs right through town, we sit amid hundreds of miles of trails and back roads, and there's a row of 14,000-foot peaks just west of town.

Thus I may be the least-traveled free-lance writer in America. Even so, I do need to get out once in a while, and I do find it true that travel is educational.

For instance, I thought I knew something about rural poverty -- my county's median household income

is well below the state average -- until I spent a few days wandering around northern New Mexico.

And I'd always heard that eastern Oregon was fit only for hold the earth together, but I was pleasantly surprised by the region's beauty last summer on a road trip to visit our daughters in Bend and Eugene. More education.

This summer, my kids were coming to visit me. But I couldn't escape the travails of travel. My wife's mother's family was holding a reunion in Laughlin, Nev., which is on the Colorado River about 100 miles south of Las Vegas. Martha hadn't seen her mother or sisters for five years, and there were cousins she hadn't seen in 50 years.

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Spread of Bighorn Sheep Pneumonia Continues | Aug 25, 2010 02:30 AM

By Jule Banville, guest blogger 8-23-10

The deadly spread of pneumonia in Montana’s bighorn sheep population picked up momentum west of Anaconda, where a hunter alerted Fish, Wildlife & Parks of possible disease in the Lost Creek population. Biologists killed four sheep and confirmed through lab work they were infected. FWP announced the latest outbreak today, which occurred in the sixth bighorn sheep population in west central Montana.

FWP, in its killing of suspected sick sheep, is continuing an experimental and aggressive battle against the easily spread and usually fatal respiratory disease.

“We’re too early in this to know everything we’d like to know. But, until we are able to survey and collect more sheep, we have to proceed as if we are dealing with a pneumonia outbreak,” said FWP Wildlife Biologist Ray Vinkey. “We can’t afford to miss the chance of removing the last sick sheep before they infect the rest of the population. Right now we’re taking it one day at a time.”

A hunter, Wayne Estay of Butte, first reported signs of sick sheep west of Anaconda during a preseason scouting trip on Aug. 17.

Vinkey and another FWP wildlife biologist, Jay Kolbe, responded and shot the sheep that exhibited clinical signs or behavior suggesting pneumonia. According to an FWP news release, they collected blood and tissue samples for further analysis at the FWP wildlife lab in Bozeman. Autopsies showed everything from early to advanced infection in the lungs, which in the worst case had also compromised the heart and liver. The varying stages of infection suggest that the disease is spreading over time.

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A fast year

Mark Trahant | Aug 24, 2010 07:30 AM

Lessons from the Indian Health System

A year goes by fast. Way too fast. Thirteen months ago I plunged into my “year-long” exploration of the Indian health system. It’s been fascinating because there has so much activity: Congress enacted the Patient Protection and Affordable Care Act and included with that bill the permanent authorization of the Indian Health Care Improvement Act.

My idea was to explore two basic questions. First, what lessons from the Indian Health Service ought to be a part of the national health care reform debate? And, second, what is the impact of health care reform on the Indian Health system? (I’ll write about that next week.)

In some ways the first question is the most difficult because of its complexity. The “story” of the Indian Health Service told in Congress and by news organizations is primarily the story of how the government runs a health care delivery system.

Sometimes that even reflects a positive message.

“It may come as a shock to many that when I compare the private insurance industry to the Indian Health Service, VA, Medicare and Medicaid, it is the private insurance industry that is the worst,” writes Dr. Richard Anderson in the Cody Enterprise. “The reason for this is that when compared to government agencies, insurance companies are not in the business of providing health care benefits as much as the denial of such benefits to make a profit for shareholders. That's why government agencies have much lower overhead and are more efficient in delivering services.”

Far more often, however, the story is about how government fails as a provider. A recent post on is an example of that narrative: “So, if you’re in the camp that supports a Medicare-for-all-type solution to our health care woes, consider how that same government, whom you’re entrusting to be the single-payer, has neglected the Indian Health Service.”

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From payment to prevention

Mike Leahy | Aug 24, 2010 05:37 AM

Restoring wolves to their native habitat in the West hasn’t been easy. Some were opposed to the idea from the start, including ranchers who already viewed wild predators as a threat to their livelihoods. That’s why compensating ranchers for losses to wolves was an integral part of promoting tolerance, even before wolves were reintroduced.

 Wolves have always gotten more than their fair share of attention for preying on livestock. When bad weather devastates a flock of sheep, or dogs kill a calf, it rarely makes the press. But when a wolf kills a sheep or two, it often makes front-page headlines. However, based on National Agriculture Statistics Service and wolf management reports, wolf depredations account for less than one percent of livestock losses in the Northern Rockies, including unconfirmed losses. Far more livestock are killed by disease, bad weather, birthing problems and other predators – even stray dogs – than by wolves.

 Yet there’s no denying wolves do sometimes kill livestock, and when they do, there are financial and emotional costs to the livestock producers. That is why the compensation program run by Defenders of Wildlife was important, a recognition by those who wanted wolves back on the landscape that livestock producers should not have to bear the costs alone. Since 1987, ranchers have been paid more than $1.4 million by Defenders of Wildlife for verified losses of cattle, sheep, guard dogs and other domesticated animals. These payments represented a tangible investment in the wolves’ future from Defenders of Wildlife to protect both livestock and wolves.

After 23 years of Defenders of Wildlife managing a wolf compensation fund, the states are now developing compensation programs of their own. Last year, Congress enacted legislation introduced by Senators Jon Tester of Montana and John Barrasso of Wyoming to provide $1 million to help states initiate their own compensation programs for livestock lost to wolves. Awarded funds are to be used both to compensate ranchers for verified livestock losses to wolves and to implement nonlethal tools for preventing conflicts. At the same time, the U.S. Fish & Wildlife Service and National Fish and Wildlife Foundation have recently established the Mexican Wolf Interdiction Fund that will compensate ranchers in New Mexico and Arizona for livestock lost to wolves and help fund wolf deterrence projects.

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Conservation groups reject deal for Child Nutrition Program

Felice Pace | Aug 23, 2010 05:55 AM

The Capital Press – a western agricultural weekly – is reporting that “conservation groups” are part of a coalition of agricultural and other organizations opposing cutting the U.S. Department of Agriculture’s Environmental Quality Incentive Program (EQIP) in order to fund the Obama Administration’s drive to expand child nutrition programs – including the innovative farm-to-school program. On the surface the opposition seems to make sense: Ag lands are key to conserving biological diversity as well as to cleaning up our rivers and streams, and USDA conservation programs promise to pay agricultural producers to do just that.

But as Congress, the USDA Inspector General and I, on this blog, have reported, USDA conservation programs too often transfer money to those who own agricultural land without realizing the promised conservation benefits. One of the programs that has been subject to this sort of abuse since its inception is water conservation under EQIP.

Using EQIP funding for “on farm water conservation” began with the 2002 Farm Bill, which provided $50 million dollars for what became known as Klamath EQIP. The idea was to fund improvements in farm irrigation efficiency. The saved water would not be diverted from the Klamath River and tributary streams, and therefore, would improve flows for salmon and other fishes.

It sounded good, but that is not the way it worked out. In spite of a clause in the Farm Bill protecting information on individual projects funded by the government (essentially making that information the equivalent of a trade or national security secret),  I was able to document the fact that the program was most likely resulting in MORE water use and LESS water in the Klamath River.

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