One day before Sebelius’s interview, another AP piece detailed the shortcomings of the painfully underfunded IHS. Operating with half the necessary funds, some understaffed clinics can’t provide preventive care services, and others can’t handle the high disease rates. Patients recount what they rightly see as subpar care: clinicians dismissing a patient’s pain from advanced frostbite until she threatened suicide; being unable to make appointments; diagnosing a five-year-old who had complained of stomach problems with depression. (After many months, several more clinic visits, and a collapsed lung, she was diagnosed with terminal cancer at a Denver hospital and died weeks later.)

The dismal statistics of American Indian health disparities are well documented (go here, here, here, and here for starters). President Obama cites a couple of the more startling ones on his website, including that men living on South Dakota’s Pine Ridge and Rosebud reservations have the second-lowest life expectancy in the western hemisphere. The health disparities are, as Sebelius says, “unconscionable.” But so are the funding disparities.

This report from the U.S. Commission on Civil Rights compared spending on American Indian healthcare to other groups for whom the government provides care. The numbers are telling: In 2003, the government spent $6,000 for each Medicare recipient, $5,200 for every veteran using the VA, and $3,725 for federal prisoners. American Indians: $1,600 per person. IHS spends less on its patients than any other group providing public care – and about 60 percent less than average per capita healthcare costs nationwide. From the report: “This disparity in spending is amplified by the poorer health conditions of many in the Native American community and represents a direct affront to the legal and moral obligation the nation has to improve Indian health status.”

That “legal and moral obligation” dates back to 1787. Many treaties and much legislation has been passed to ensure healthcare for American Indians, notably the Snyder Act and the Indian Health Care Improvement Act, which states, “It is the policy of this Nation in fulfillment of its special responsibilities and legal obligation to the American Indian people, to assure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy” [emphasis added].

The 2010 HHS budget is $828 billion ($872 billion after additional funding from the American Recovery and Reinvestment Act of 2009) - the amount spent on American Indian healthcare will make up approximately 0.5% of that. And if we funded the IHS at the levels officials say it requires – around $7 billion – that would still make up less than 1% of the entire budget. Obama’s $454 million bump provides the IHS with just over half of “all resources necessary”- ensuring that our historic failure isn’t coming to an end anytime soon.

For more reading:

Native Health Needs and Federal Apathy Are Told at an IHS Conference

Indian Health Care Needs Patient Information and Funds

Tribal Leaders Seek Health Care Reform

State Treasury Must Help Pay What Indian Health Service Doesn’t Provide

The History and Politics of US Health Care Policy for American Indians and Alaskan Natives

Redeeming Hollow Promises: The Case for Mandatory Spending for American Indians and Alaskan Natives

“If You Knew the Conditions”: Health Care to Native Americans

CDC Office of Minority Health and Health Disparities

Office of Minority Health

U.S. Senate Committee on Indian Affairs