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SUMMARY OF HISTORY

Summary The preceding section provides a basis for understanding the historical evolution of the Indian Health Services. While the establishment of IHS did not occur until 1955, the concepts of dependency-to-self determination and tribal sovereignty have been a long standing tradition. Likewise, policies undertaken by the federal government to maintain its provisionary role has fluctuated with the political currents and national mood. The conflict between intent and outcome of these policies that were made by non-Indians have fostered conflict and mistrust. Efforts to change this premise for interaction between the tribes and the federal government have included the legislation of the 70s. The 80s was a decade where the testing of the Self-Determination Act took place. This movement toward tribal control of health facilities through contracting processes set the stage for the current IHDT plan to take the next step in transferring power and authority in a formal and permanent manner.

The influx of federal dollars to the reservations in the late 60’s and through the 70’s was an offshoot of the Johnson War on Poverty. Although many tribal leaders regarded this financial assistance "as fulfilling previous treaty commitments…[it was tragic] because this interpretation of federal assistance gave an artificial boost to the emerging doctrine of tribal sovereignty that distorted the Indian vision of political and economic reality " (DeLoria, p. 251). The money came because Indians were poor, not because they were separate nations with a binding treaty of obligation. Indian "success and failures have been connected to the Indian status as an identifiable racial minority with American society, not to the status of Indian tribes as domestic…nations" (DeLoria, p. 255). If the premise of sovereignty was not particularly strong, an even more undermining current was running through the 80’s implementation stage. The policies in the 80’s became…

…entangled with exceptions as career bureaucrats resisted the policy of turning large areas of responsibly over to the Indians. The goal….was to reduce the number of federal employees substantially and allow a greater decision-making process at the reservation level. Unfortunately, most of the bureaucrats involved insisted they had to oversee tribal decisions because of their role as trustee…[T]he final product…was simply to duplicate already existing agencies and branches of the government with tribal operations (DeLoria, p. 253).

So the values and beliefs that were shaped by history were coming into conflict with new concepts for public administration. Economic constraints would also provide an impetus for change. That change would involve a shift of power and authority. Older bureaucratic institutions were perceived as not being able to deliver the social functions that they were designed to do. The early 90’s raised the call to "reinvent" government". A new conservative Congress that demanded accountability was ushered into office in 1992. The stage was being set for the IHDT as these streams merged.