Healthcare going forward

[Benvolio]

It's been a couple of decades since I worked with the Indian Health Service but from my experiences there in the 80s, it was as bad as Africa (only with lots of alcoholism). From what I'm hearing from counterparts in public health is that the casinos have significantly improved conditions since the 80s- financial and otherwise- for the tribes. One of the problems that they're having to deal with is that they've never had to run businesses and manage money, so they've had a learning curve of how to manage too much money.



In addition to the treaty obligations for things like education and healthcare, there's a big budget allocated under BIA for land and water management. It's incredibly complicated but apparently there's a large amount land in trust that the Feds manage but that's a different budget from the budget subsidies that we were originally discussing before this latest Benvolio derail.

Correct me if I'm wrong since you know more about Indian financing than I- but the assumption that Indians are paupers supported by the Feds is a stereotype and because of casinos and other tribal investments, they're not as socially subsidized as other populations.



I'm not going to justify his desperate attempts to somehow link federal subsidy to anything other than "white people" but it is fair to say that what these states have in common is a dying tax base (ergo the term "rust belt") and an aging, infirm population.

The reason that states like Georgia, Texas and Kansas don't show up in the top 10 can be summed up by a look at the finances of cities like Atlanta, Dallas, Houston, Austin, Topeka and Kansas City- vibrant cities with growing populations and dynamic economies.

South Carolina, Florida and Louisiana don't have growing vibrant cities? Of course the do.

 

[KaraBulut]

South Carolina, Florida and Louisiana don't have growing vibrant cities? Of course the do.

You haven't been to South Carolina (26/50) or Louisiana (4/50) lately, have you? Florida's (rank 30/50) real estate market has recovered around Tampa and Miami... the rest of the state is not doing so well. And if you don't think that Florida has a disproportionate number of retirees on SSDI/Medicare or a large number of Medicaid participants (Florida did not accept the Medicaid expansion but has a number of public hospital districts)...

 

[TX-Beau]

It's been a couple of decades since I worked with the Indian Health Service but from my experiences there in the 80s, it was as bad as Africa (only with lots of alcoholism). From what I'm hearing from counterparts in public health is that the casinos have significantly improved conditions since the 80s- financial and otherwise- for the tribes. One of the problems that they're having to deal with is that they've never had to run businesses and manage money, so they've had a learning curve of how to manage too much money.

My experience on the subject goes back a ways also. I used to do a lot of work for Native Orgs that were studying exactly that, the effect of gaming on Tribal communities. It was mostly funded BY Casino Tribes in California. What we basically found was (wait for it) that the effect was not uniform, and that it depends on who you're talking about, where they are, and how any profits are distributed. There are more tribes by far without casinos than there are with them, and although all of us tend to think of Native Americans as kind of a monolithic thing, those Morongos aren't interested in sharing with the Navajos. Plus not all Casinos are the big profitable ones, and a bunch of them did fold because of bad management or lack of customers.

It also depends on what kind of casino the Tribe built, were they the sole shareholder, or did they take investment from some outside entity for a share of the profit - in which case they may own the casino, but they don't run it and they don't unilaterally control the profit. Some Casinos are managed by management firms that are hirelings and not Native.

As far as effect on things like healthcare - first of all, if your Tribe doesn't have a profitable casino, things are no different for you than what you found in the 80's. That said, effects on social expenditures depended on how casino profits were handled. There are two basic models, the state (Tribe) manages the revenue and centrally decides on spending priorities, and the Per Capita model, under which all profits are divided between each Tribal member.

The PerCap tribes did not see a general improvement in Tribal social services - and you have to understand that we are not talking about large numbers of people, but then they didn't really need that since they had the cash to outright purchase whatever they wanted, which wasn't always healthcare and schools. This model seemed to be corrosive on the Tribe, instigating feuds about who got on the rolls and who didn't, there were no uniform Tribal spending priorities, plus they tended to throw up stringent membership requirements for future membership so as not to dilute each individual's PerCap dividend. The highest PerCap I ever saw was ~$80,000.00, per month, per person.

The State model tribes did much better and are probably the kinds that your friend is talking about. They did invest in education and healthcare and sent all their kids off to law school, they also hired lawyers and enacted laws like a ban on Tribal Members gambling in their own casinos, and requiring that all employees be Tribal members - with some exceptions based on skilled labor. The individual Tribal members did not get a stipend or a dividend. They did get schools and hospitals. However, unless something has changed pretty radically, the effect of casino money on Native Americans across the board has been largely incidental. Hospitals the rich ones pay for, are not open to the poor ones from elsewhere.

There are variation on these, but it just gets even more arcane.

The most interesting reaction to Casino money I ever saw though was what happened when White neighbors began seeing large amounts of political donations coming from the Casino Tribes. That got visceral and ugly.

In addition to the treaty obligations for things like education and healthcare, there's a big budget allocated under BIA for land and water management. It's incredibly complicated but apparently there's a large amount land in trust that the Feds manage but that's a different budget from the budget subsidies that we were originally discussing before this latest Benvolio derail.

The Fed is trustee to all lands owned by the tribes (except in Texas), and their revenues, there was a huge lawsuit about that just recently, since it came out that $19 billion dollars owed to Tribes seemed to be missing. Imagine that.

Correct me if I'm wrong since you know more about Indian financing than I- but the assumption that Indians are paupers supported by the Feds is a stereotype and because of casinos and other tribal investments, they're not as socially subsidized as other populations.

It runs the gamut, if you have a PerCap chances are you can buy both of us before lunch and aren't going to bother with getting and keeping any form of welfare. Then there are Reservations that are so poor and destitute it's literally the third world.

With regards to social services, the biggest misconception is that White people generally think that providing schools and healthcare to Natives IS welfare, but it's not, it's the agreement the Fed made for their land. We agreed to provide these things in perpetuity for the land we parked our big lily behinds upon. If a rich tribe wants to take Federal money, they are entitled to do so, if they don't, that is probably the biggest contribution they make to all the others.

There was some talk of "Pan-Indian" identity and causes, awhile ago, but I have no idea how popular that was or if it ever went anywhere.

 

[thewiz]

Actually, one of the reasons for the higher rate is that those states have large military bases. The investment of the military counts as dollars coming back to the state -- which it does in the form of wages/salaries for both military personnel as well as support.

 

[Kulindahr]

Reservations don't pay tax dollars to the state and usually the Fed either. They get "return" from everyone paying into the Fed based on the Trust obligations (the Fed declaring them all wards of the state and taking "in trust" their welfare and property) and Treaty agreements entered into by the Fed (except Texas.) If you include them in some kind of "return" you also have to acknowledge that they didn't contribute to the income tax base, are not under the jurisdiction of the States (which have no power to tax them in the first place.) Saying they are why ND is getting more than they pay in, is at best a gross oversimplification since ND isn't obligated to pay for them and doesn't take taxes from them.

It's more complicated than that but that is basically the situation on most reservations. It's also the reason people like Trump went to Natives and offered to finance their casinos (he fucked them over - big shock) no taxes, no local jurisdictions.

Ben is saying that ND is getting more BECAUSE of Reservations. That's bunk, no matter the state of ND's finances, they didn't pay any more for the reservation than CA did. They also took no taxes from the reservation. Pretending that is the cause that people in ND who pay their income taxes and then THEMSELVES take more from the Fed is just lying.

So reservations would indeed skew the figures, since federal money flows to them but none from them, since all that the article was looking at was tax dollars flowing out of the state to D.C. and then federal dollars flowing from D.C. into the state.

So the question would be the population of the reservations to that of the state as a while -- if it's high, then this could be a significant factor; if low, probably not.

 

[Kulindahr]

How did we get from healthcare to farm subsidies?

Just fishing around for things that would make some states get more back in comparison to others without it necessarily being welfare-ish.

 

[Kulindahr]

It's been a couple of decades since I worked with the Indian Health Service but from my experiences there in the 80s, it was as bad as Africa (only with lots of alcoholism). From what I'm hearing from counterparts in public health is that the casinos have significantly improved conditions since the 80s- financial and otherwise- for the tribes. One of the problems that they're having to deal with is that they've never had to run businesses and manage money, so they've had a learning curve of how to manage too much money.

The reservation near here had a very straightforward approach to that: they used casino money to pay for the education of any member who wanted to get a college degree in business management and other skills needed for the tribe! And meanwhile they built new housing for those in low-quality dwellings, built their own schools, and even helped pay for the churches on the reservation to put up new buildings (which had to fit aesthetically or get nothing). Since then they've built their own medical facility as well.

 

[Kulindahr]

Actually, one of the reasons for the higher rate is that those states have large military bases. The investment of the military counts as dollars coming back to the state -- which it does in the form of wages/salaries for both military personnel as well as support.

Ah -- that' what was tickling my mind earlier! I kept thinking "missile silos" and knew there was darned well more to it than that!

I know North Dakota has Minot, Grand Forks, and Fargo, and that's probably not even half.

 

[Kulindahr]

Just a thought:

providing medical care for everyone going forward would be a cinch if we paid off the debt. So real patriots would want to tax everyone to the limit to get rid of the debt, and end that taxation over say three years after the debt was gone, putting the excess into an endowment for medical care, one for the national parks, and one for the U.S. highway system.

And that would make sense for the wealthy, since people with little to spend aren't going to be customers.

 

[Kabluey]

...And that would make sense for the wealthy, since people with little to spend aren't going to be customers.

For some reason, the wealthy want to believe that their consumers have unlimited funds and access to debt.

Mind you, those who think so are the same people who argue the environment can be infinitely polluted.
Externalities.
Someone elses problem until their private beach clogs up with waste, or their housemaid gets cholera, or people stop shopping at their widget mart.

That's how billionaires operate in places like South East Asia. Usually they just get angry.

 

[Kulindahr]

For some reason, the wealthy want to believe that their consumers have unlimited funds and access to debt.

Mind you, those who think so are the same people who argue the environment can be infinitely polluted.
Externalities.
Someone elses problem until their private beach clogs up with waste, or their housemaid gets cholera, or people stop shopping at their widget mart.

That's how billionaires operate in places like South East Asia. Usually they just get angry.

I suspect that after my honors course in Form and Function my expectations of how easily people will see synergy at work are a bit high.

 

[Kabluey]

I suspect that after my honors course in Form and Function my expectations of how easily people will see synergy at work are a bit high.

Jerks tend to spoil ideals fairly efficiently.

 

[TX-Beau]

So reservations would indeed skew the figures, since federal money flows to them but none from them, since all that the article was looking at was tax dollars flowing out of the state to D.C. and then federal dollars flowing from D.C. into the state.

So the question would be the population of the reservations to that of the state as a while -- if it's high, then this could be a significant factor; if low, probably not.

IF the people who built that chart included reservations anywhere, then their methodology is flawed. No tax dollars flowed to ND FOR the Reservation. Period. ND has nothing to do with funding or allocating anything for or from the Reservation. It is a separate system entirely.

All money spent on that Reservation or revenues from it are managed and allocated through the BIA at a Federal level and ND has fuck all to say about that, and nothing to do with it.

Ben's contention based solely in racism, has no foundation in reality. As usual.

 

[Kabluey]

South Carolina, Florida and Louisiana don't have growing vibrant cities? Of course the do.

A big part of the reason some states get more federal funding than they pay on federal taxes is because their economies are underperforming.
How else can DC be contributing $38,000 per capita in federal taxes while Mississippi contributes $3,800 per capita?

https://en.m.wikipedia.org/wiki/Federal_tax_revenue_by_state

 

[KaraBulut]

...With regards to social services, the biggest misconception is that White people generally think that providing schools and healthcare to Natives IS welfare, but it's not, it's the agreement the Fed made for their land. We agreed to provide these things in perpetuity for the land we parked our big lily behinds upon. If a rich tribe wants to take Federal money, they are entitled to do so, if they don't, that is probably the biggest contribution they make to all the others....
All money spent on that Reservation or revenues from it are managed and allocated through the BIA at a Federal level and ND has fuck all to say about that, and nothing to do with it.

^^Bears repeating. Because these are Treaty funds, it's part of a separate budget and it's not part of the numbers that we were discussing.

IF the people who built that chart included reservations anywhere, then their methodology is flawed. No tax dollars flowed to ND FOR the Reservation. Period. ND has nothing to do with funding or allocating anything for or from the Reservation. It is a separate system entirely.

The authors based their numbers on information that I just found on a .gov website.
https://www.usaspending.gov/transparency/Pages/default.aspx

So, if you want to see the state breakdowns, look here:
https://www.usaspending.gov/Transparency/Pages/StateAssistance.aspx?statecode=ND&fiscalyear=2017

There's a dropdown where you can select the state you want to see if you want to see a state other than North Dakota.

So, I noticed that one of the payees that had Federal Contracts was the "Spirit Lake Tribe" (Indians!). On the same website, you can search to see contracts and payments made to the Spirit Lake Tribe.

• Most of the payments to the Spirit Lake Tribe were for Department of Defense contracts. For example, $222,068 was paid to the Sioux Manufacturing Corporation for "TEXTILE FABRICS". $294,403 was paid by DoD for "PLASTICS FABRICATED MATERIALS for COMBAT VEHICLES". So, these are "welfare" payments- they're contracted payments for manufactured goods and services.
• There's also payments to like the $3,774,451 paid to the University of North Dakota.
• There's also $2,250,927 that the Department of Agriculture paid to BENDICKSON FARMS. In fact, if you look through the list, there's lot of "Farms" on the list.
• If you look through the $463,432,024 in payments to the State of North Dakota, there's a lot of payments coming from Department of Veterans Affairs, Department of Energy, Department of Defense and Department of Homeland Security.

...Ben's contention based solely in racism, has no foundation in reality. As usual.

As usual, yes.

A big part of the reason some states get more federal funding than they pay on federal taxes is because their economies are underperforming.
How else can DC be contributing $38,000 per capita in federal taxes while Mississippi contributes $3,800 per capita?

^And this is the point of discussion. The states that are struggling with declining economies and who focused on obsolete industries in the 20th century are the states that are are paying in less and taking out more from the federal budget.

So, bringing this all back to topic.

The irony of the situation that we're in is that the states that voted for Trump in the Presidential election are going to take the biggest hit if Medicaid is reduced and if the subsidies for Marketplace plans are reduced.

These states also contribute less in individual income tax payments and state transfers of funds back to the Federal Government. So far, the infrastructure projects and contracts haven't been been the priority. Somehow "fixing the failing Obamacare system" by cutting Medicaid has become the priority and that's going to hit the very people who voted for Trump in the hope of "making America great again".

 

[frankfrank]

I also find it amusing that they can support Reagan, who essentially imposed an unfunded mandate on hospitals by requiring people to be aided regardless of ability to pay.

I'll say it again. I FULLY EXPECT REPUBLICANS TO REPEAL THIS. I probably posted that thought as long as seven or eight years ago, and I think I even considered it an "unfunded mandate" back then.

In all the reading I have ever done, I have still NEVER seen anybody else suggest what I've suggested, though I'm sure it must be out there somewhere.

Another way to kill off the "undeserving and undesirable" poor "freeloaders."

 

[Stardreamer]

So now Ryan is saying we have to shove this crap down the American People's throat NOW or they never will. And we have the President saying if it doesn't pass, plan B is let the ACA fail and blame Democrats.

The Republicans are shamelessly making themselves hypocrites with this incredible rush to pass this bill by April. They complained over and over that Democrats rushed the ACA through the Congress but they spent a year working up to the vote.

Trump's plan B has a couple of major problems. One is the ACA may take years to fail if it does at all. And if it does fail, Trump and the Republicans are NOT the ones who get to say who is at fault. The American People do and they tend to blame who had their hands on the issue last. Its too late to let think that the Republicans will not at least share the blame if not get all of it. If They hadn't passed the EO and made this attempt to pass this bill they might have been able to avoid blame but they are involved now.

 

[Kulindahr]

IF the people who built that chart included reservations anywhere, then their methodology is flawed. No tax dollars flowed to ND FOR the Reservation. Period. ND has nothing to do with funding or allocating anything for or from the Reservation. It is a separate system entirely.

All money spent on that Reservation or revenues from it are managed and allocated through the BIA at a Federal level and ND has fuck all to say about that, and nothing to do with it.

Ben's contention based solely in racism, has no foundation in reality. As usual.

You're contending that there is no connection between the economies of the reservations and the rest of the state?

I just want to know whether they included it.

 

[rareboy]

Stupid Trump/Pence voters.

but typically.....all for repeal of Obaamacare, but not the roll-back of Medicaid that covers their own ailments.

They will hopefully get exactly what they voted for.

Too bad they are taking millions of others with them.

https://www.theguardian.com/us-news/2017/mar/12/republican-healthcare-trump-pence-medicaid-indiana

 

[gsdx]

^ Sadly, they're now finding out just what Trump thinks of them and just how bleak their future is.