Trahant: Indian country and health care reform: Insurance for the family selling pinions
My family and I walked around the flea market here Saturday. I’ve always thought this is the ideal representation of unabashed capitalism. It was hot, dusty and there were hundreds of booths and thousands of people buying and selling a remarkable range of goods, animals and services.
On one hand there are the types of items you’d find at any flea market: Used car parts, clothes and carnival-quality toys. But add to that mix Native foods such as Acoma bread, mutton stew or dried corn; plus traditional products such as mountain tobacco, Navajo and Pueblo jewelry, live sheep and horses, and CDs loaded with musical selections from traditional to Rez-style Hip Hop.
|To say the current system isn’t working well for small businesses is an understatement.|
Gallup may be a tourist town, but not many travelers venture from I-40 into the hot summer market. That’s too bad – they’d find great bargains, but it’s a lot easier to buy Indian jewelry from a modern air-conditioned trading post. No, this market is directed at primarily Navajo and Zuni customers, local people serving local people. That, to me, is the essence of small business.
Yet I don’t suspect the family selling pinion nuts is thought about as a small business in the context of health care reform. Small businesses are viewed as much bigger enterprises, for example a construction company with a dozen or so employees.
“Small businesses play an important role in the U.S. economy,” said a new report released by the White House last week. “The vast majority of firms in the United States are small, and these firms account for a substantial share of private sector employment.”
Indeed these are the very firms that cannot afford to pay health insurance premiums for their employees. As the White House report points out: “The current U.S. health care system is not working well for small businesses. Most obviously, small businesses pay substantially more to provide insurance for their workers. On average, small businesses pay up to 18 percent more than large firms for the same health insurance policy.”
Of course this issue is even more complicated in Indian country. Let’s use the construction company as an example. If most of your employees are Native American (and eligible for IHS services), or seasonal hires, it’s awfully difficult to justify paying private insurance premiums. Then there is the growing number of Native American families that ranch or farm (the Census reported a significant rise in this category in 2007). Or the family business that gathers rice or pinions, operates a booth at the flea market, travels through the summer to pow wows to sell frybread and tacos. For these ventures, there is no incentive to buy health insurance. Consider the philosophical question: Should (or even can) a reservation-based entrepreneur subsidize a treaty right to health care?
While I was walking around the market, the president talked about the needs of small businesses. He’s right to focus on the health care needs of small businesses – but I think this conversation must also include the changing nature of work.
As more and more of us leave the corporate working world – complete with health care benefits – and venture into our own version of the flea market, we will need a health care system that includes a viable self-insurance option, both in the larger community and for people in reservation-based economies. That’s why a public plan is essential to any reform.
But it must be a public option that recognizes the variety of work in this country. The definition of “affordable” needs to satisfy people who might earn a fabulous paycheck during fishing season – and then coast for months after that. The public option will have to include people who might use IHS for primary care, but who would be willing to pay extra for some services.
To say the current system isn’t working well for small businesses is an understatement. But it’s much deeper than that: We’re looking at the very proof that this country made a mistake by linking health care to employment.
Mark Trahant is the former editor of the editorial page for the Seattle Post-Intelligencer. He was recently named a Kaiser Media Fellow and will spend the next year examining IHS and its relevance to the national health reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. www.marktrahant.com