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As I sit here in Pablo, 1,900 miles from Washington, D.C., I fear the debate on health care has gotten so mired in the weeds that the country has lost sight of the big picture. There is one absolute bottom line: Neither Montana nor the country as a whole can afford not to enact health care reform. The consequences of inaction will be disastrous.

First, we need to make sure we are talking about the same thing. We err in continuing to use the phrase "health care reform" when in fact the pending legislation addresses the issue of "health insurance reform." The pending issue is not socialized medicine or a governmental takeover of the delivery of medicine but rather establishing standards that would apply to the various insurance companies and certain practices those companies have undertaken that have hurt millions of Americans. Under this reform, your doctor will not change; your hospital, clinic or doctor's office will not change. None of the bills in Congress or anything proposed by the Obama Administration contain any language that would get in the way of your relationship with your doctor and if you like your current insurance plan nothing would require you to change plans or companies.

Why must we do this? As indicated in a series of well-known studies, the reasons we cannot afford to do nothing are simple and without dispute:

- Since 2000, average family premiums in Montana have increased 83 percent to the point that they average almost $13,000 a year. As a result fewer businesses are able to offer their employees health coverage. Montana is a small business state;

86 percent of all businesses in Montana are small and due in large part due to these rising costs only 31 percent of them offered health benefits to their employees in 2006.

- Obviously with rates this high, many families cannot afford health insurance on their own. In fact almost one in every five Montanans is uninsured and of those without insurance, almost 70 percent include families where at least one member is employed full time.

- More than $2,000 of the $13,000 Montanans spend on health insurance premiums is essentially a hidden tax people pay to subsidize the costs of the uninsured. When folks without insurance get sick and end up in hospital emergency rooms those costs eventually get passed on to those who do have insurance.

- If the increases in health care continue, one of every four dollars in our national economy will be spent on health care by the year 2025. Americans already spend more per person on health care than any country in the world and yet are less healthy than the residents of most other developed nations.

If Congress does not address this problem, it will be a total abdication of their duty. That is why I am pleased to see Sen. Max Baucus, D-Mont., and President Barack Obama working so hard on trying to find a workable solution.

So why would a tribal chairman from western Montana be concerned about this? Don't Indians get their health care from the Indian Health Service, a branch of the Public Health Service? Well we don't have much of an IHS presence on the Flathead Reservation and have no IHS hospital or even a significant IHS-run clinic. We are therefore overly reliant on what is known as Contract Health Care, where the IHS pays for the costs of private doctors. Unfortunately the appropriations committees have for decades not funded it at even a basic level of need. We also contribute to a self insurance fund and like everyone else, we would like to see those costs reduced and health insurance reform would help accomplish that.

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My other interest relates to a recent visit by a Fox News reporter to an Indian reservation in South Dakota. He made the argument that if the IHS couldn't provide decent health care there, how could the federal government do so nationally? This is the first I had heard of Fox News being concerned about the health of the American Indian people. The crocodile tears they shed were not only disingenuous but a continuation of their misleading attacks on anything Obama. They were comparing apples to oranges. On the reservations they visited, the federal government, through the IHS, is providing direct care with federally employed doctors and nurses.

If the debate in Washington was over the question of whether we should have nationalized health care then comparisons to the IHS might be interesting and educational. That is not what is on the table and Fox knows better. What is pending is legislation that would, among its other positive components, prohibit insurance companies from cancelling policies when their customers get sick. Isn't that something we would all want to see?

The time has come for straight talk and actions, not politically inspired games to see who can get the upper hand before the 2010 elections.

James Steele Jr. is the tribal council chairman of the Confederated Salish and Kootenai Tribes of the Flathead Reservation and serves as chairman of the Montana-Wyoming Tribal Leader's Council.

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