Measuring a Benefit
Usually this time of year as Council wraps up the budget our email inboxes, phones, and actual mailboxes get a slow trickle of correspondence from Tribal members offering all sorts of opinions on how Tribal dollars should be spent. Just in writing that first sentence I was tempted to say we were "flooded" with comments, but that would simply not be true. A busy year might generate dozens of comments, but when you consider that our Tribe consists of now more than 5200 total enrolled members, "dozens" looks more like a drop than a deluge. The year 2011 appears to have generated fewer comments than in the past, something that I think could be attributed to numerous factors, one being apathy, and a major one being people now have social media message boards in which to vent. And vent they do.
It will surprise nobody that many of the budget comments we get pertain to member benefits, specifically per capita. Some members are thankful. Others naturally want to know why per capita has diminished over the last few years, a legitimate question to which there are a variety of answers. I could do a whole blog post on that, and probably will later. But for now, aside from the obvious answer of a nationwide recession, the reality is with less dollars we are at a point where the core services we provide our Tribal members have become competitors for funding. One of those is our Tribal member health plan.
Several years ago I had Finance staff accumulate the sum total of dollars the Tribe has paid towards our three main gaming-dividend funded benefits of per capita, elders security, and the Tribal member health plan since 1996. Earlier this month I asked them to do it again. All told, they add up to a lot, as in hundreds of millions. Up until recently, per capita was the reigning king of the budget jungle, consuming 25-35% of the gaming dividend-funded portions of our Tribal government during better economic times. But then in 2009 a funny thing happened: the cost of our Tribal health plan ascended the throne, that is it surpassed per capita, and has remained there ever since. Ironically, we have managed to realize some savings in the plan, none of which have prevented it from remaining our most expensive member benefit. To give some perspective consider this: At the beginning of the decade in the year 2000, the Tribe spent roughly one-third of what we spent in 2010 on our Tribal health plan, even though our Tribal population only grew from 4500 to 5200 in that same span. Our health plan increased more than 300% while our membership grew by 15%. Health care, simply put, costs a lot and is not getting cheaper. You could practically amend that famous quote about "death and taxes" to include rising health care costs.
Whether all the membership truly benefits from what we spend on our health plan is probably going to be debated, especially with a number of members who barely use it at all due to already having insurance or being uncannily healthy, the latter which included me up until this year. In fact I was one of those people who had to be embarrassed into returning the health plan survey in 2009-2010. Though far from being a health and fitness nut, in general I exercise, eat well, have had few health-related problems historically, and am only 36 years of age. In other words I go years without seeing a doctor, and thus have had little reason to utilize our health plan.
But 2011 for me was the health equivalent of having all the planets align, as I encountered a nagging knee problem which had me go to a specialist, a severe ear infection that meant seeing another specialist, and an annoying dermatological ailment which also took me to--you guessed it--a specialist. Visiting a ear, nose, and throat doctor due to the ear infection led to discovery of another problem, which resulted in my undergoing septoplasty surgery after Thanksgiving. In total, I've made 15 different visits to several different doctors the past year.
Getting copies of the charges has been enlightening, even though I've yet to get a year-end total. But comparing what my health issues cost our plan as opposed to what I received in per capita isn't really necessary. In my case the value of being under the Tribal health plan wins hands down, not just monetarily but in peace of mind. I can only imagine how invaluable our health plan is for many of our Tribal members with recurring health problems, and graver issues that require months of medical attention and can be life-threatening.
I don't expect to win over any of those people who think that per capita should be the number one priority of Tribal Council when we approve the budget. But for me personally, in 2011 I learned the value of good health, and of knowing that the Tribe will do everything possible to keep Tribal members healthy. You can't put a dollar value on that. Okay, actually we can put a dollar value on it as evidenced by our annual budget. But the real value, quality of life, transcends any dollar amount.