This column was originally published on Substack.

Mark Trahant*Substack*

Mary Peltola said something interesting on the campaign trail last week.

From Alaska Public Media:

“Peltola portrayed herself as a different kind of Democrat. Rather than defend the actions of the Biden administration that Sullivan tried to saddle her with, Peltola skewered Biden’s Interior secretary — and pinned blame on Sullivan.

“My opponent, he voted yes to confirm Deb Haaland, who was one of the biggest stumbling blocks Alaska’s ever seen,” Peltola said.”

That’s rich. Both Senators Sullivan and Lisa Murkowski voted for Deb Haaland. And former Rep. Don Young was vocal about his support, too. But this represents Peltola’s brand. She is running on a her being pro-Alaska and a “different kind of Democrat.”

In that same debate, her opponent, incumbent Sen. Dan Sullivan, repeated a variation of a theme, citing her “lower 48 liberal allies” 15 times in the hour-long forum, with slight variations.”

National Democrats would laugh at that.

Again, from Alaska Public Media in a story headlined: “Peltola’s votes show she’s one of the least loyal Democrats in the U.S. House.”

“Democrats in the U.S. House almost always vote in line with party leaders, but Congresswoman Mary Peltola’s voting record suggests she’s one of the chamber’s least loyal Democrats.

She’s bucked the party on 78 votes since the start of 2023. That’s a “ votes against party” rate of more than 12 percent, the fourth highest among House Democrats, according to data gathered by ProPublica. The average House Democrat votes against the party less than 6 percent of the time.”

This exchange has me thinking broadly about the candidates who represent different constituencies across Indian Country. And, at the same time, there are a lot of differences beyond tribal citizenship. That’s a given since there are Native Democrats and Native Republicans. Add to that the perspective of Native Democratic Socialists and Native MAGA Republicans. Nuance.

We all carry a flag (even as independents) of some sort. But that doesn’t mean everyone under that same banner proposes the same solutions. I think it’s worth exploring these differences because it’s OK to disagree with someone on more than a few issues, and still think they should be elected. Right?

None of these divides are unique to Native candidates (but we do gloss over them more because they all “represent” us.)

Take “socialism.” The scary word of the moment. What exactly do we mean? If socialism determines the state ownership of, say, health care, then does that also include the state ownership of public companies on the stock market? As an op-ed last month in The Los Angeles Times said: “The Trump administration’s investments in corporate stocks make it a significant shareholder in an unprecedented 30 companies. Voters and economists are uneasy.”

Beyond the label of socialism, there are practice and priorities. It’s not just state control, it’s the state control over the issues that one side thinks are most important.

An issue that divides: Health care

Let’s explore some of our differences on health care policies. (A stand in for other ideological divides, ranging from Israel to “electability.”)

Start with the Republicans.

Rep. Tom Cole, Chickasaw, supports a “private sector” approach to health care, including health savings accounts.

“More than half of Americans obtain their health insurance through private health insurers. I strongly support a role for private enterprise in American healthcare and believe the answers to our nation’s health care problems entail market-based solutions, not in granting the federal government sole control over the nation’s health care industry,” he recently wrote.

Cole, and all elected Republicans, opposed the Affordable Care Act. He wrote: “President Obama and the Democrats created a program Americans cannot afford, that works for big insurance companies, instead of patients, and that is filled with waste, fraud, and abuse.”

On the MAGA side of the Republican team, Rep. Joshua Chad Brecheen, Choctaw, has called for more significant reductions in federal health spending, especially Medicaid.

I have never understood health care as a program for the “truly needy.” But that’s the MAGA Republican messaging.

I should point out that as long as President Trump leads the Republican Party , there are not as many serious policy differences between traditional GOP members and MAGA. That will end, though, after Trump. The differences are there (trust me on that.)

Now the Democrats.

Both Mary Peltola, Yup’ik, and Rep. Sharice Davids, Ho-Chunk, represent a liberal status quo, an incremental approach. That means restoring Medicaid funding. Davids also supports a public option.

Jonathan Nez, Navajo Nation, is another centrist Democrat on health issues. But he brings a lot of practical experience to the table; he was leading the Navajo Nation during the COVID-19 epidemic and had to make difficult public policy choices to slow the virus. He said at the time that the epidemic exposed serious gaps in the nation’s public health programs.

Then there’s Deb Haaland, Laguna Pueblo; Claire Valdez, Ysleta Del Sur Pueblo; and Peggy Flanagan, White Earth Nation. These three women all see health care as a right. Period.

Haaland has made health care a central issue in her campaign for governor in New Mexico.

“Deb Haaland, one of two Democrats vying for the nomination in New Mexico’s gubernatorial race later this year, vowed to fix the state’s “broken” health care system at a news conference in Albuquerque on Tuesday.

“Health care is not a luxury. It is a right,” Haaland said.

“Haaland said her plan to fix health care for New Mexicans includes protecting Medicaid, recruiting and retaining providers, bolstering rural health care, combating private equity, lowering prescription drug costs and expanding insurance coverage.”

Valdez describes herself as a Democratic Socialist and sees Medicare for All as the way forward in her campaign documents.

“Claire will sponsor Medicare for All on Day One and fight the insurance companies that profit from denying care and driving up costs. No one should lose their health care when they lose a job, and no one should have to choose between seeing a doctor and paying rent.”

Peggy Flanagan also favors a single payer system, Medicare for All.

From Flanagan’s priorities document:

“Peggy believes healthcare is a human right and will fight for Medicare for All, ensuring providers, clinics, and hospitals have the resources to give people the care they deserve. She knows we need to consider the impact on workers across the board as we make this change. Until that plan passes, Peggy will fight hard to expand access to care and rein in insurance company greed.

“Peggy believes it’s time to ban insurance companies from using prior authorization processes for care. Too many Minnesotans have sat on the phone and begged their insurance company to cover a prescription medication, a treatment, or a surgery. A stranger behind a desk or an AI algorithm shouldn’t be able to deny you care your doctor prescribed.”

To me a single payer health care framework is inevitable.

The thing is — and it’s something I have written about often — our current health care system is broken beyond repair. The United States spends more on health care than any other nation on the planet — and yet we get less in outcomes and benefits than any other industrial nation.

As Kaiser Family Foundation notes:

“Generally, the U.S. performs worse in long-term health outcomes measures (such as life expectancy), certain treatment outcomes (such as maternal mortality and congestive heart failure hospital admissions), some patient safety measures (such as obstetric trauma with instrument), and health system capacity (such as rate of general practitioners). The U.S. performs similarly to or better than peer nations in other measures of treatment outcomes (such as mortality rates within 30 days of acute hospital treatment) and some patient safety measures (such as post-operative complications).”

It’s also a budget issue. Yale School of Public Health:

“A single-payer universal health care system could cover every American, save more than 100,000 lives a year, and still cost $1 trillion less than the system it would replace, according to a new preprint study led by researchers at the Yale School of Public Health.

“For the study, which has not yet been peer reviewed, the researchers modeled what would happen if the United States adopted a national public insurance program like the one proposed in the Medicare for All Act. Using 2024 spending, insurance coverage, and mortality data, they estimate that the universal coverage would reduce annual health expenditures by $1.04 trillion, or nearly 20 percent — even after accounting for the additional care that uninsured and underinsured people would receive.”

Back to the “differences” among candidates: We need differences. We need critics. We need advocates. We need status quo. And we need leaders who push us in a new direction. This diversity of view makes for a better conversation (something missing from political discourse in the Trump era) because it helps us reach a smarter conclusion.

That is an idea goes well beyond public health.

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