Ka Wai Ola - Office of Hawaiian Affairs, Volume 11, Number 2, 1 February 1994 — Lewin: R for Hawaiians lies in trust relationship, federal reparations [ARTICLE+ILLUSTRATION]

Lewin: R for Hawaiians lies in trust relationship, federal reparations

by Jeff Clark In the opinion of state health director John Lewin, M.D., if the U.S. acknowledged the existence of a trust relationship with the Hawaiian people, Hawaiians would be eligible for a lot more in the way of health care (as well as programs in other areas of need). Lewin says that through the Native Hawaiian Heahh Care Act, Medicare and Medicaid, Hawaiians get about $700 - 800 per person in health benefits, whieh he calls "a pittance." If Hawaiians had the same poli(ical standing with the U.S. that Native Americans have, he continues, Hawaiians would get about $2,000 of benefits per person. That extra $1,200 per person would mean $240 million coming into Hawai'i for the heahh of Hawaiians. "All of us in Hawai'i pay federal ineome tax. We ought to get that same level of benefit, and fight for that until we get it for native Hawaiians, in addition to whatever land solutions and other kind of reparation solutions are negotiated," Lewin says. "That $240 million would really help us in many ways,to develop prevention models, community-based approaches, and add to the access to Western health care but also to native healing practices, and to deal with the design and heahh of family and community models for Hawaiians that would help restore heakh and well-being." Lewin has concrete ideas about how to get health subsi- » dies for pawaiians frōm the federal government, ideas that go beyond Clinton's health plan. Rather than include

Hawaiians in the federal Indian Heahh Service, "We would want to use the Indian Self-Determination Act approach, Public Law 93-638, whieh incidentally I had the opportunity to help write when I worked with the Navajo tribe in the early 1970s, so I know the law very well. "That law says that Indian tribes or Native American

people, indigenous people in Ameiiea who were displaced or defeated at the hands of the American government, and removed from their native lands, practices and their culture, ... ean receive the money unto themselves in a block grant on a kind of per-capi-ta equivalent to what the nation is spending for the tribes for whieh the Indian Heahh Service provides the care. "And in that way (Hawaiians) ean then develop a culturally sensitive, self-deter-mined approach. And they ean also make sure that they get all the training programs to create iobs for Hawaiians at the same time.

"The beauty of that is you don't import a bunch of nonHawaiian heahh providers to provide care, you train Hawaiians and create a new eeonomie ffontier in this area with this tremendous employment that comes out of the heakh profession. That's the direction that I see out there for Hawaiians, and I really look forward to having a role in that." 1 s ' • '

But the final answer lies in political change. "We obviously have to encourage the sovereignty movement and the movement toward self-determination of the Hawaiian people to be able to preserve the culture that benefits all of us." In the meantime, there is the Office of Hawaiian Heakh, whieh Lewin admits is merely a token effort.

"I'm not going to pretend it's anything but tokenism compared to what we should be doing." Lewin says he has requested four additional staff for the office, to be located on the neighbor islands in the community hospitals, in this year's budget request. "What they would do would be to work with the families and the individuals who are admitted to the hospitals to see about creating community outreach and services for them so that onee (they are) discharged that somehow in the home community there is a context of healine so that thev will not be back in the

hospital. "And the idea also is to provide a connection between Western health care, particularly for people who are the sickest, and traditional native Hawaiian healing strategies. So it's a really expiting model for how we ean bring these two ideas together. That's a little bit of progress in a zerobudget year." « i i : 1 , . ' 'i : . \ •! !

nīih.ī' John Lewin, M.D.