:: to the teeth ::   thoughts on social justice, medicine, race, hope and beats
"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::
"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Monday, May 31, 2004
Update on the effort to rebalance the mission of Albuquerque's public hospital:
Urban Indian advocates re-establish some equity in the hospital
So, for the past two years, our coalition has been negotiating with the CEO of our public hospital to change some heinous policies and reinstill a sense of mission in the institution. our efforts have focused mostly on homeless, immigrant and uninsured populations. turns out that parallel to us, urban indian advocates and IHS (Indian Health Service) administrators were doing the same thing. few facts. Albuquerque has about 30-45 thousand urban indians who theoretically have health care coverage thru the IHS. reality check is that all the money goes to the tribes of origin so these folks would then need to travel back to their reservations to receive the benefit. up until a few years ago things were sort of balanced because the pueblo tribes near albuquerque put a significant chunk of their money into the albuquerque IHS clinic which was able to serve these people with primary care and urgent care. a few years ago many tribes took advantage of a new law called "638" to take all their money back to their tribes. this has bankrupted albuquerque ihs clinic.
in the face of this the public hospital, which gets almost $200,000,000 in subsidy and tax breaks, began applying for a $250,000,000 mortgage from the feds. in order to do this the hospital had to negotiate with the indian governors to ensure that the land (which was donated by indians to establish this hospital 50 years ago) was not in any legal conflict should the hospital be unable to pay this new huge loan.
now it gets interesting. the governors have watched their equity in the hospital dwindle over the past fifty years from an initial treaty agreement to provide 100 hospital beds to a mere 8 beds held in reserve. one of the few perks that still exist is that indian patients are billed to IHS at cost, instead of inflated charges. so the governors decided to make a stand. they put together a list of 8 negotiation points that had to be agreed upon by the hospital before they would sign onto the new lease agreement. the thorniest of which is that the hospital has always been the "payer of last resort." this means that money must be collected from any other source before the hospital will give a cent. makes sense for medicare and medicaid patients so we don't tap the $200,000,000 for these patients when the federal and state governments are willing to pay.
but the governors stated that IHS now needed to be the payer of last resort for urban indians since IHS is bankrupt. the justice issue here is one of racism. an urban indian is a person who lives, works and pays taxes in a city. he or she is a citizen. the whole notion of forcing people to go back to their reservations for health care when they are entitled as any other resident to services where they live is discrimination. the hopsital had no qualms in seeking the assistance of Senator Dominici from NM to try to force the IHS to stop their complaining and accept a bad deal. rumors were flying about how expensive it would be for the hospital to shoulder the burden. lies were stated about how IHS wanted the hospital to pay for care for all indians in the state (12% of the population).
here are a few more details. the new lease is for the next 50 years, so a bad decision made today is gonna last a long long time. the second fact is that the cost of urban indian care at UNMH is roughly 1.1 million per year. a drop in the bucket.
with a little help from our coalition and a lot of backbone and courage and work from IHS officials and urban Indian activists, this stupidity was put to a stop and the CEO was forced to honor the initial treaty that created the hospital and share some equity with Urban Indians. of course, what's on paper is just a place to start. now the harder work begins to ensure that people get their due. we already know the financial aid system is set up to exclude indians and immigrants and homeless people. it's not policy, it's process. this is where the efforts of the community coalition in alliance with urban indians, will work to monitor and hold the hospital accountable to their mission.
the added benefit from this recent conflict is that the CEO is pissed. :> he's not happy when he is forced to share public tax dollars with the public. now that urban indian activists and the coaltion activists are allies in the open, he's got more to worry about. the usual tactics of divide and conquer aren't going to work anymore. a cold hard truth is that those tactics have worked. too many immigrants believe that indians have all the healthcare they need and too many Indians believe that immigrants get free health care. the truth is so much more complex and disastrous than that. as long as we fight each other, we'll never unveil the truths and lies of oppression and achieve a just society.
posted by andru | 5/31/2004 10:42:00 PM | |
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