If filmmaker Michael Moore really wanted to shock the world about the lack of health care in the United States, he should have taken his film crew to an Indian reservation for scenes in his recent documentary "Sicko."

Imagine Avis Littlewind, a 14-year-old who was lying curled in the fetal position for 90 days before killing herself because no treatment center existed to help her.

On Wednesday, the Senate Committee on Indian Affairs held a field hearing on the Crow Reservation to collect testimony from Native people suffering at the hands of the Indian Health Service, which is funded at barely half of its need.

About 200 people arrived at Crow Agency, including national health care administrators, tribal leaders and Native patients, all of whom provided testimony on the state of Indian health care. The committee will continue to accept written, faxed and e-mailed testimony for two more weeks.

"You know something?" Sen. Byron Dorgan, D-N.D., told fellow lawmakers in Washington, D.C., on July 31, in remarks recorded into the Congressional Record. "On that Indian reservation where Avis Littlewind lived, there were no mental health treatment facilities for someone to take this young lady, this young girl. One might ask and certainly should ask: 'Why is it in this country that mental health treatment is not available to a child like this?' "

Dorgan, chairman of the Senate Committee on Indian Affairs, led the Crow Agency field meeting, which was requested by Sen. Jon Tester, D-Mont. The hearing was held as the Senate Finance Committee prepares for a Sept. 12 markup of the Indian Health Care Improvement Act. The act has not been updated and reauthorized in 15 years.

"Year after year this Congress postpones it," Dorgan said to members of the Senate Finance Committee in July. He called Indian health care an "urgent national need."

The Indian Health Service, a government entity created in response to the federal government's trust responsibility to Natives, was created to fulfill health-care promises to indigenous people who gave up hundreds of millions of acres of land in exchange for reservation life.

"We do have some trust responsibility here," said Tester, during a phone interview after Wednesday's hearing. "The next step is to get the Indian Health Care Improvement Act passed. Get it out of the Finance Committee and get it passed through the Senate and get it to the president's desk."

He said testimony and data from the field hearings would be sorted, compiled and used to ensure adequate funding and staffing for Native health care. Tester and Dorgan are also moving forward on legislation that would empower tribal colleges to begin training people to fill medical needs in nursing and administration. The legislation has not yet been brought before the Senate Committee on Indian Affairs, said Tester.

Meanwhile, Wednesday's hearing made it clear there are two distinct world views between high-level Indian health administrators and the workers and patients in the trenches.

"This isn't something new," Tester said. "Sen. Dorgan and I both asked questions about if the budget was adequate. But they really refuse to say they're inadequate. And then when you hear what's going on, on the ground from the providers and from the patients, they talk about running out of health care on the first of June. You hear about people who only get health care if their life is in danger or if they are going to lose a limb."

Panelists at the Crow Agency hearing spoke of woefully inadequate funding of contract health services. "The truth is, what we're doing in Indian Country is rationing health care," said Tester. "It needs to be said."

Dorgan said the same in the July Congressional Record, when he described Ardel Hill Baker's health care experience. While the woman was having a heart attack, a reservation health-care worker taped a note to her thigh before sending her off in an ambulance to a nearby hospital.

When Baker arrived, the paper on her leg could not be missed. Dorgan interpreted the note for the Senate Finance Committee.

"It says to the hospital: 'By the way, if you admit this person, you are on your own because our contract health-care money is gone.' "

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