Indian Health Service A celebration of the Indian Health Service in 1992.

A year goes by fast. Way too fast. Thirteen months ago I plunged into an exploration of the Indian health system. It’s been fascinating because there has so much activity: Congress enacted the Patient Protection and Affordable Care Act and included with that bill the permanent authorization of the Indian Health Care Improvement Act. 

I explored two basic questions. First, what lessons from the Indian Health Service ought to be a part of the national health care reform debate? And, second, what is the impact of health care reform on the Indian Health system?

In some ways the first question is the most difficult because of its complexity. The “story” of the Indian Health Service told in Congress and by news organizations is primarily the story of how the government runs a health care delivery system.

Sometimes that even reflects a positive message.

“It may come as a shock to many that when I compare the private insurance industry to the Indian Health Service, VA, Medicare and Medicaid, it is the private insurance industry that is the worst,” writes Dr. Richard Anderson in the Cody Enterprise. “The reason for this is that when compared to government agencies, insurance companies are not in the business of providing health care benefits as much as the denial of such benefits to make a profit for shareholders. That's why government agencies have much lower overhead and are more efficient in delivering services.” 

Roberto Gallardo/ProPublica The map shows the distribution of stimulus funding in rural counties only. State capital counties have been taken out, since they receive a disproportionate amount of stimulus money. This is the amount of stimulus funding that has been spent through the first half of this year. To see a larger version of the map, click on it.

Who’s getting rich off the stimulus, the $787 billion federal spending bill Congress passed in February 2009?

Are urban counties slurping up all that money? Or rural?

Are counties that voted for Barack Obama receiving more money than those that sided with Republican John McCain in 2008?

The nonprofit reporting organization ProPublica has put together a database of spending projects paid for by the stimulus package. ProPublica has broken down the spending by county. The database contains information on $350 billion in stimulus money spent through June of this year. 

So, we decided to see if anyone seemed to be benefiting more than others as billions of federal money is distributed. (Roberto Gallardo, a research associate at the Southern Rural Development Center at Mississippi State University, conducted the data analysis.)

The short answer is that, yes, some counties have gotten more of the stimulus money than others. But, there doesn’t seem to be much of a pattern when you compare per capital stimulus spending at the county level.