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"Government-run" no longer defines the Indian health system

Mark Trahant | Aug 18, 2010 01:00 AM

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.”

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New Mexico gets most back from Washington

Ed Quillen | Aug 17, 2010 03:00 AM

Since this is an election year, it's time to ponder politics. Let's ignore policy and platforms for the moment, and look at money. Which state's congressional delegation is best at delivering the dollars? 

The champion team is in the West. According to statistics compiled by the Tax Foundation in Washington, D.C., New Mexico's representatives and senators lead the nation in bringing home federal money.

The foundation calculates how much federal money a state receives for every dollar of federal taxes it pays. In the 2005 fiscal year (the most recent year available), people in the Land of Enchantment received $2.03 from Washington for every $1 they paid in federal taxes.

That made New Mexico first in the nation, and the foundation's historical record , going back to 1981, shows New Mexico as the leading state every year, although it's down a little from its record of $2.33 in 1988. It hasn't mattered whether the state's delegation is dominated by Republicans or Democrats.

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Rants from the Hill: A thousand-mile walk to home

Michael Branch | Aug 16, 2010 03:00 AM

“Rants from the Hill” are Michael Branch’s monthly musings on life in the high country of Nevada’s western Great Basin desert.

Three summers ago I blew out a lumbar disc while running a jackhammer in the desert near my house—an accident that was the result of simple bad luck, with the odds perhaps skewed by the fact that a jackhammer was the wrong tool for the job and alcohol may have been involved. After a long, miserable recovery period during which I was as ornery as a walleyed mule, I finally healed enough that my wife, Eryn, could get me out of the house, which was a great blessing to her. At that time Eryn asked what turned out to be one of the best questions I’ve ever received: “Now that you’re able to walk again, how do you want your life to be different from life before the injury?” Without thinking I replied, “I just want to walk and walk and walk.”

In that moment I came up with an idea that was ridiculously arbitrary: I would walk 1,000 miles in the next 365 days, and I’d start every walk from home—an approach that was practical, since we live adjacent to BLM lands stretching all the way to California. Why one thousand miles in a year? Why not? I didn’t have a single good reason, no justification, not a hint of a plan. Nor did I have any idea how far 1,000 miles really was, though it sounded like a big number. Once I started to break it down, though, I realized that I wouldn’t need to pull heroic, big-mile days of the sort done by long-trail hikers on the Pacific Crest Trail. While 1,000 miles sounds impressive, it amounts to just 2.74 miles per day, which seemed incredibly modest. Just 2.74? I reckoned people probably walk poodles farther than that.

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Who is the California Farm Water Coalition?

David Zetland | Aug 12, 2010 07:55 AM

Editor's note: David Zetland, a water economist at the University of California, Berkeley offers an insider's perspective into water politics and economics. We will be cross-posting occasional posts and content from his blog, Aguanomics, here on the Range.

Mike Wade, Executive Director of the California Farm Water Coalition, has often commented (or been quoted) on this blog and other places in favor of continuing or increased water deliveries to agricultural interests. 

And I have often disagreed with the way that Mike has presented his case. 

What bothered me was Mike's dogmatic insistence that water for ag was more important than water in other places. It reminded me of how a lawyer or lobbyist would say or do anything to benefit his client.

And that made me wonder just WHO Mike's client was. It also made me wonder if CFWC was not violating its status as a 501(c)3 non-profit, which forbids lobbying* legislators on particular legislation (such as the water bills or how to allocate federal stimulus money). 

In response to this second question, Mike sent an official letter [pdf], stating that

The Coalition supports the current water bond, however we have expended no funds nor do we expect to do so in promoting it if it makes it to the ballot for a vote. While we believe the goals of the water bond are in line with the beliefs of a majority of our members, our goal is to educate rather than advocate.

Now, I don't know about you, but Mike's time costs money and Mike's advocacy in favor of the bond therefore appears to "expend funds."

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The data story: How much? How many?

Mark Trahant | Aug 10, 2010 02:00 AM

WASHINGTON, D.C. – Every agency that serves American Indians and Alaska Natives must answer these questions in order to fuel the decision-making process: How much will it cost? How many people are served? And, by the way, who is an Indian?

None of the answers are easy. The demand for federal services is growing as resources shrink. And in the health care arena the key to sustainable funding is Medicare and Medicaid (including the Children’s Health Insurance Program) where definitions are complicated by multiple factors.

Consider eligibility: More than 560 tribal communities with members living on or near reservations or spread out in urban areas. Each tribe defines its membership but that data is rarely collected for use in health statistics because it’s often privately held. The U.S. Census allows each individual to define his or her own status by checking a box. (Some 5 million by this count.)

The Indian Health Service has another definition that adds descendants of enrolled members to the mix. And it collects data through its area offices, not states. Many IHS boundaries and reservations cross state lines, further confusing the data.

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Another way to see immigration

Ed Quillen | Aug 09, 2010 07:50 AM

A friend pointed me to an interesting article about immigration from Mexico, especially into the American Southwest.
 
In essence, it argues that this is not some internal U.S. law-enforcement issue that can be resolved by intensive policing, like Arizona's controversial recent effort.
 
Instead, our Southwest is typical of borderlands throughout the world, and the current controversies are part of a long and contentious relationship between the United States and Mexico -- one that started with the Louisiana Purchase of 1803, twenty years before Mexico became an independent country.
 
The two nations fought a war in 1846-48, followed by the Gadsden Purchase of 1853, to establish a political boundary, but cultural and economic boundaries shift over time, even if the political boundary remains fixed. Immigration is just one of many issues. 

If you share my pleasure in history mixed with geopolitics, read it here.

Ed Quillen is a freelance writer in Salida, Colo.

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Who's burning the forest?

Felice Pace | Aug 09, 2010 05:00 AM

High Country News' recent feature on arson (The Fiery Touch, August 2nd edition) provides a fascinating look into changing attitudes toward citizens who light wildfires without official permission. Wildfire arsonists have gone from something like hero status to criminal status … at least in urbanized areas.

But what interested me more was senior editor Ray Ring’s take on western wildfire issues as expressed in that edition’s Editor’s Note. After walking through and studying all the large fires in Northwest California since 1987, I am in full accord with Ray’s statement that “many Westerners still view wildfires as primarily natural events. But actually, most or all of today's wildfires are either caused by human beings or made worse by human actions.”

Ray goes on to clarify: “two big factors influence how much it (a wildfire) burns. Our dedication to aggressive fire suppression over the past century has allowed an unnatural buildup of fuels on the public lands. And climate change -- driven by our heat-trapping emissions of carbon dioxide and methane -- results in worsening droughts, higher temperatures, insect epidemics and other stresses that make vegetation more prone to burn.”

This is, of course, the current dogma promoted by the huge, powerful and permanent firefighting bureaucracy led by Idaho’s National Interagency Fire Center. It does not square with my personal experience of what is actually taking place in our western forests. Based on that on-the-ground experience, I believe the impact of 90 years of aggressive fire suppression has been seriously overestimated. In much of the West’s backcountry fire suppression has never been effective; consequently its impact on today’s fire behavior is limited there.

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Colorado's bizarre primary

Ed Quillen | Aug 06, 2010 03:00 AM

About 20 years ago, the Colorado General Assembly moved the state's primary election from September to August. Cynics figured there was a reason, something like this: Coloradans are on vacation in August, or at least getting outdoors at every opportunity, so they're not paying attention to politics the way they would in September. An August primary thus means less attention and a lower turnout, thereby giving the party establishments more power. 

But if that was the plan, it went seriously off the rails this year. It's a vote-by-mail election that concludes on Aug. 10, and already county clerks are reporting returns of 20 to 25 percent -- high for a primary.

That's because both major parties have hot races. The statewide contested Democratic race is for U.S. Senate. Ken Salazar won the seat in 2004, but resigned to become Secretary of the Interior. Gov. Bill Ritter {who is not seeking re-election) appointed Michael Bennet to serve until the election.

Bennet was a surprise. He had been Denver school superintendent and chief of staff to Denver Mayor John Hickenlooper (the Democratic nominee for governor), but he had never held a political office.

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Big Ag sells to Big Urban

David Zetland | Aug 04, 2010 03:00 AM

Editor's note: David Zetland, a water economist at the University of California, Berkeley offers an insider's perspective into water politics and economics. We will be cross-posting occasional posts and content from his blog, Aguanomics, here on the Range.

I've been participating in an email discussion about Westland's plan to sell 50-100,000 acre feet of water to Metropolitan Water District (Spreck broke the news; this article gives more background).

This ag-to-urban, central-to-southern California sale upsets enviros. Why?

  1. Westlands Water District has been making A HUGE FUSS about how it needs MORE water. How is it possible now that they can be selling water? (Short answer is that WWD has to sell it, to avoid losing it from storage; the long answer is that WWD will eventually sell ALL of its water to SoCal urban buyers. No, it's NOT about the workers, food or community. It's about MONEY.)
  2. MWD's water has driven SoCal sprawl, and more water means more lawns at MWD and more sprawl into new housing developments.
  3. Some enviros just dislike WWD (and other irrigators using imported surface water); they want it shut down and its water left in the environment/Delta.

I am not upset about these "business facts" (or even anti-ag emotions), especially when water is going from willing sellers to willing buyers, for beneficial use.

OTOH, I am not happy about this (prospective) sale:

  1. WWD water is subsidized.That means that price may be too low and profits come out of our pockets.
  2. A backroom sale does not allow others to bid. That's not good from a social perspective.
  3. Feinstein and other politicians are writing special rules, changing the definition of water rights to make them worth more cash -- and more water -- when we have already overallocated our water supplies. These special interest giveaways merely rob The Public a second time.

My suggestion? WWD auction its "surplus" water to the highest bidder and use the revenue to repay the money it spent to acquire it.* The remaining money should stay at WWD, as a reward for its special relationship with DiFi and others. (I don't like those special interest/lobbying rents, but I don't think they should be taken away. We need politicians who are brave enough to change the policies that produce these rents. Anyone?)

Bottom Line: Water trading is good, as long as the good for sale is clearly owned and the price reflects its real cost.
* It's interesting that they are talking about a water swap -- 3 af today for 2 af in the future -- instead of a cash sale. The swap makes sense for three reasons: (1) They do not want to haggle over price (except that "net af" of water), (2) they do not want the public to know how valuable the water is if it WAS priced, and (3) they do not want to worry about cash flows. OTOH, the swap creates a long term relationship (good!), but also creates uncertainty. Will MWD be able to return the water in the future? What if it's dry for 5 years and MWD needs the water for toilets, showers and lawns?
Addendum:

Tom Birmingham wrote me an email on this post, and I am waiting for him to let me post it as a comment. Until then, the gist of his comment is that this is a swap, not a sale, and that MWD has the storage space to let it happen. I replied that this swap seems a poor substitute for a market (in which WWD and MWD would be able to buy and sell when and if they wanted), but a necessary substitute given the current distribution of water rights -- a distribution that favors WWD and MWD over other water users.

Originally posted at Aguanomics.

 

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Over the River controversy continues

Ed Quillen | Jul 29, 2010 06:05 AM

The Bulgarian-born artist Christo specializes in gigantic installations -- like wrapping the Reichstag in Berlin, or arranging hundreds of fabric gates in New York City's Central Park.
 
For the past decade or so, he's had plans to return to Colorado with "Over the River." (His first Colorado project, an immense curtain in Rifle Gap, was about 40 years ago.) He proposes to suspend translucent panels over the Arkansas River between Salida and Canon City for a two-week period, perhaps in August of 2013. You can read more from Christo here .

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