What do Trump, Janklow and a Russell Means lightning strike have to do with Rounds and the IHS?

Not long after Mike Rounds made the Janklow-Trump comparison, lightning struck and I lost power – along with the interview notes on my computer screen.

Yeah, yeah, I know. I should have been saving those notes. But sometimes when an interview gets good, as this one did, a guy gets busy asking question and pounding the keys and forgets about hitting the “save” key.

Ka-boom. Notes. Gone. Ouch.

Have to admit, right there I thought of Russell Means, who said a couple times in the months leading up to his death he wanted to come back as lightning and strike the White House. I think of Means regularly when lightning strikes. You don’t suppose he took a shot at Rapid City, when he heard Trump and Janklow in the same sentence?

Anyway, with the computer flashing like it was shot with a rifle, I grabbed a pencil and scribbled down what I could remember to that point, including a couple quotes, and asked for help in reconstructing a few others. But much was lost.

It was good stuff, too. But it didn’t start with Trump and Janklow. It started with questions on the Indian Health Service troubles, something  that is currently engaging Rounds, a former two-term governor now in his second year as our junior U.S. senator. That makes John Thune the senior senator, of course, but he probably already notes that when the kids at McDonald’s automatically give him the senior discount. (Come, senator,  they do. Admit it!)

Whatever the age and rank, Thune, Rounds, and Congresswoman Kristi Noem have been working on the Indian Health Service medical-care fiasco with passion that mostly seems to transcend politics. Obviously, the fact that by bashing the IHS the Republican congressionals indirectly get to bash the Obama Administration is a sweet GOP bonus.

But there’s real outrage and concern there, too, with good reason. IHS in this region in particular is a mess. While there is certainly good care being provided in some instances, it fails in others. Hence the closed ER at the IHS hospital in Rosebud and long, dangerous and — some tribal members say —  in some instances deadly delays in critical treatment as ill or injured patients are rushed to other hospitals.

As Noem said recently in one of my TV interviews, the federal government has a treaty obligation to provide health care to Native people through the IHS, and “we are failing.”

There are plenty of reasons for that, including a stone-walled institutional structure in IHS that makes it as bullet-proof against transparency and responsiveness as any agency at any level I have covered. There might be good people doing good work inside the figurative and literal walls of IHS, but you’d never know it.

I’d have better luck getting an interview with a member of the Politburo than getting into the office of whoever is in charge at Sioux San Hospital here in Rapid City, or other IHS facilities in Rosebud or Pine Ridge, with my camera rolling.

Why is that? I have to think the military basis for the IHS is part of it. Even though their work hardly constitutes national security missions like the duties of officers and airmen at Ellsworth Air Base, many IHS leaders are still military. And there’ a sense in the military, in my experience, that says: “We’re kind of immune from the public openness rules others play by.”

And they probably kind of should be when real national security is at stake. But what’s at stake in the IHS works is health and lives. And openness, not secrecy, is the way to help protect those.

Add funding shortfalls the IHS can’t control, the complicated relationships between the federal government and the sovereign-yet-dependent tribes, throw in some politics, mix in profound health-care challenges among tribal people and the isolated reservation landscapes and you’ve got health-care dysfunction beyond your imagination.

Or as Rounds said, speaking of the deeply troubled Rosebud IHS facility, “some of the stuff that went on down there is terrible.”

All at the expense of tribal people.

But what about Trump and Janklow? Not yet. First, the life-and-death realities, offered by Rounds before the lightning struck:

The IHS Great Plains Area, which includes South Dakota, North Dakota, Nebraska and Iowa has:

  • The 2nd highest rate of infant mortality among all IHS regions.
  • The highest diabetes death rates (129.7 per 100,000 compared to IHS average 65.6 and U.S. average 23.3)
  • The second-highest in alcohol related deaths (77.0 per 100,000 compared to 44.7 IHS, 6.9 U.S.)
  • The highest tuberculosis death rates (3.2 per 100,000 compared to 1.0 IHS, 0.2 U.S.)
  • The lowest life expectancy rate at 68.1 years as compared to the U.S. average of 77.7 years.
  • The highest age adjusted death rate (1301.5 per 100,000 is higher than IHS average of 953.7 and U.S. average of 776.5).

Terrible stats, Rounds says, but there are more from the senator:


  • IHS allocates less than 0.4% of its total budget to equipment purchases.
  • It appears only one-third of IHS’s roughly 15,000 employees (full time or equivalent) are dedicated to front-line health care professionals (doctors and nurses, for example).
  • Of its 15,000 employees, IHS has more than 3,700 people dedicated to Medicaid billing (25%) while only 750 people are identified as doctors (.05%).
  • IHS spends less per capita than the Bureau of Prisons spends on each inmate. ($3100 compared to $5100 annually)


More than that, Rounds says IHS isn’t even particularly responsive to the tribes when it comes to crucial decisions affecting the tribes.

“There has been minimal or no consultation at all with tribes on those decisions. They’ve simply too often been left out of the discussion,” Rounds said. “And that’s got to stop.”

Money is a factor, too. And just about everybody agrees the troubled region needs more of it. Rounds says the funding formula doesn’t’ seem to make sense or have a structure, other than what has previously been given to the agency and to a region.

I’ve said before and continue to content that the IHS lost a great opportunity when former South Dakota Sen. Tom Daschle withdrew name from consideration for health and human services secretary. He had issues to deal with in being confirmed by the Senate. But they could have been overcome had Max Baucus, then a Democratic senator from Montana and alleged Daschle friend, been truly supportive and had the Obama Administration been more resolute in backing Daschle.  Knowing both the D.C. system and the IHS system, especially in this region, Daschle would have meant real change for the better.

But we have what we have, including an apparent commitment of the state’ Republican delegation to force improvements.

Rounds says an independent audit is needed, and he’s encouraged by IHS cooperation there. He will join Thune and Noem this Friday in Rapid City for a field hearing on IHS issues by the U.S. Senate Committee on Indian Affairs and its chairman, Republican Sen. John Barrasso of Wyoming.

The hearing won’t be the end of the IHS inquiry, however.

“We want to make sure it’s clear that we’re not going away this time,” Rounds said. “We have to stay on top of this until there’s systematic change in the IHS, but always in cooperation with the tribes.”

Now, when you think “cooperation” don’t you think Janklow, and Trump?

That’s not exactly what moved the interview to those two. Actually, I wanted to talk Trump with Rounds even before the Senate hearing came up, so I tagged some questions on to the end of the interview.

Like Thune and Noem, Rounds has endorsed Trump (last I knew, Gov. Dennis Daugaard still had not). And I guess I can understand the endorsements, since the billionaire is almost certain to be the GOP presidential nominee, and these folks play the political game at the national level, where partisanship is most, well, pervasive.

But, I asked Rounds, whose political life has been represented by polite commentary and the general rejection of name-calling and personal invective, if he wasn’t troubled by Trump’s vulgarities and pejoratives and personal attacks.

Doesn’t it make Rounds uncomfortable?

“Yes, it does,” he says. “And I tell people that there are some things that Trump says – good goals, changes that need to be made, bringing jobs back, strong national defense – that people agree with.”


“He says things that I would not say,” Rounds said. “I wouldn’t say it like he says it. I just don’t use that kind of language.”

That’s been my experience with Rounds, on and off the record. My experience with Janklow, on and off the record, was much different – especially off. He said things on the record that would make a half-drunk cops reporter blush. Mostly, but not always, he was more careful on the record.

But he still crossed lines of rhetoric than Rounds wouldn’t have crossed. As a state Senate leader, Rounds worked with Janklow on many initiatives and admired his performance as governor, if not always specifics of his public rhetoric.

“There were times when I’d walk into his office and say, ‘Bill, why did you say that?’” Rounds recalls.

If you loved Janklow and loved his Wild Bill style, and plenty of South Dakotans did, you also embraced some of what he said that some might have considered over the line.

He was pretty good at personal attack. And great at bullying. I can’t imagine, though, that he ever would have suggested we ban all members of a religious group from entering the country or spoken about a reporter with disabilities the way Trump did.

Then there’s the other thing: Janklow was extraordinarily bright and knowledgeable on the law, politics, government and just about any other subject he found interesting (from catalytic converters to black holes in space to the impacts of music on the developing brain of a fetus), something even his supporters would have trouble honestly saying about Trump.

Yet, you did have to look past some things to work with Janklow. Rounds did just that. And he seems to be prepared to do the same with Trump – up to a point.

“There are times when Mr. Trump has made inappropriate comments,” Rounds said. “And I won’t defend them.”

My guess is that in the coming months Rounds will have plenty of opportunity not to, again. And again.









Posted in Politics In KELOLAND.


  1. get in touch with me–I sent most of my career as a commissioned officer with the Public Health Service, mostly in South Dakota–am retired from IHS but still practice medicine–I’ll tell what is really going on Mark Butterbrodt,

  2. but you already know a big part of the problem–not lack of funding, not difficulty getting good medical providers to Pine Ridge–the acting medical director whom I’ve discussed with you several times resigned abruptly a couple of weeks ago, word has it that the IOG is looking at his work computer–he is/was the person responsible for hiring and firing, for medical quality control, for all clinical work in Pine Ridge IHS off and on for the last 20 plus years, including the recent troubled history (which really dates back much longer)–do you think I can get the RC Journal, the Argus, SDPR, NPR, Senator Thune, Senator Rounds, Rep Noem interested in this? hint: the answer is the same as the answer to whether or not all these town meetings, all these congressional hearings, all these IT schemes are going to improve life expectancy of someone living in Manderson or Parmelee

  3. Things that make me laugh:
    1 The name Rounds and audit in the same sentence.
    2 John, Kristy, and Mike are just becoming aware of these problems.
    3 NOW you want Tom Daschle’s help, but not when he was the third most powerful man in the US government
    4 Peoples willingness to side step South Dakota values to support a candidate in their party
    5 Anti-government congressmen and congresswomen that think the government is the answer.
    6 Anybody that thinks Trump and Janklow are similar
    7 I have to go. I’am belling laughing and crying at the same time

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