Indian country and health care reform: Unrealistically high expectations for tribal consulation

Op-Ed By Mark Trahant

More  than twenty years ago the BBC captured the essence of bureaucracy in  a sitcom called, “Yes,  Minister.” The basic  plot was that the Minister for Administrative Affairs, Jim Hacker, would  come up with an idea – sometimes wonderful, sometimes odd – only  to have its implementation sidetracked by civil servants.

Hacker’s  nemesis, Sir Humphrey Appleby, once described his task as “the traditional allocation of executive  responsibilities has always been so determined as to liberate the ministerial  incumbent from the administrative minutiae by devolving the managerial  functions to those whose experience and qualifications have better formed  them for the performance of such humble offices, thereby releasing their  political overlords for the more onerous duties and profound deliberations  which are the inevitable concomitant of their exalted position.”

Of  course bureaucracy in the United States is different. Our civil servants  have far less power than they do in the United Kingdom. Then again,  I remember a long-time Washington bureaucrat who once told me, “I’ve  seen ‘em come, I’ve seen ‘em go.”

Every  president is challenged by the nature of bureaucracy, and the agency  that best reflects that power is the Office  of Management and Budget.  OMB is where many good ideas all but disappear from public discourse.  The agency is a budget traffic cop, saying “no” to any agency request  that it thinks cost too much.

These  days the Nixon administration gets much credit for the president’s July 1970  Indian affairs message that called for a sharp break with the past. “This policy of forced  termination is wrong, in my judgment,” the president said. “We have  turned from the question of whether the Federal government has  a responsibility to Indians to the question of how that responsibility  can best be furthered.”

But  Nixon’s words were not all that different from President Johnson’s  message to Congress in 1968.  LBJ also said it was time to end “the old debate” about ‘termination  and he stressed self-determination. But the president’s words fell  flat because there wasn’t support in Congress or the bureaucracy for  such substantive change.

This  is the context for President  Barack Obama’s meeting with tribal leaders Nov. 5. “I know that you may be skeptical that this time will be any  different,” the president said. “You have every right to be and  nobody would have blamed you if you didn't come today.  But you did.   And I know what an extraordinary leap of faith that is on your part.”

And  that leap of faith was matched immediately with the sort of action that  doesn’t draw headlines. The president picked the OMB as the key agency to implement the government’s new policy.  “I hereby direct each agency head to submit to the Director of the  Office of Management and Budget (OMB), within 90 days after the date  of this memorandum, a detailed plan of actions the agency will take  to implement the policies and directives of Executive Order 13175.”

OMG  the OMB! (That’s “oh my god!” for those who aren’t receiving  texts from a teenager with a cell phone.)

This  is the same agency that urged President Ford to veto S. 522, the Indian  Health Care Improvement Act, in 1976 because “substantial” funds  had already been spent on Indian Health. “We believe S. 522 is a particularly  egregious example of unnecessary legislation that will result in high  unrealistic expectations among the very group it is intended to help.”

I  like the idea of unrealistic high expectations. Now that the order is  published in the Federal  Register we should expect  a real consultation process with agencies ranging from the office of  U.S. Trade Representative to the Internal Revenue Service. Consider  this process mechanism: Because the OMB is responsible for this policy,  the spending for tribal consultation by every government agency already  has a green light.

On  top of that, the task ahead will be easier because so many cabinet-level  officers were at the meeting with tribes at the Interior Department.  They already know, and get, why consultation is a big deal.

President  Obama’s directive doesn’t guarantee success. But it is a significant  step because it incorporates the bureaucracy itself into the way ahead.  This may not make sitcom fodder, but it’s important because bureaucrats  make much better partners than opponents.

Mark  Trahant is an advisory board member of InvestigateWest and a Kaiser Media Fellow examining the Indian Health Service  and its relevance to the national health care reform debate. He is a  member of Idaho’s Shoshone-Bannock Tribes.