WASHINGTON - By the end of a health care hearing March 8, the Senate Committee on Indian Affairs had forced clarity on at least two points: a bill to reauthorize the Indian Health Care Improvement Act will come to a vote in the current 110th Congress, and a Department of Justice white paper on the proposed reauthorization did in fact derail the bill last year near the close of the 109th Congress.

Sen. Byron Dorgan, D-N.D., the committee chairman, committed himself to correcting the pattern of recent attempts to enact the reauthorization, which would update government-funded health care services for Native people.

''Look, we've got a serious problem in Indian health care,'' Dorgan said from the dais. ''We've tried very hard to reauthorize the Indian Health Care Improvement Act, and I can't tell you how frustrated I am and how frustrated Senator [John] McCain was in the last Congress [when McCain, R-Ariz., chaired the committee]. Every single time we had tried to move this [reauthorization bill], we'd have an objection from somewhere, sometimes in HHS [Department of Health and Human Services], sometimes in Justice. No matter what we did, there was always another objection, and this never moved. This time it's going to move.

''People can object if they want; they can vote against it if they want. But we're not going to spend twenty-four months trying to figure out where HHS is, where the Justice Department is. ... This time it's going to move, one way or the other. And we're going to be voting on the proposal on the floor of the Senate.''

He called it ''shameful'' that the reauthorization hasn't passed Congress.

Committee member Sen. Tom Coburn, R-Okla., a physician, spoke up for an alternative view of the delay in passing the bill. In the process, he affirmed the common knowledge on Capitol Hill that he was one of the senators with a ''hold'' on the reauthorization bill in the last Congress (any senator can place a hold on any bill for any reason, delaying its consideration by the whole chamber).

''To modify ... in a very small way, without significant improvement to Indian health care, is a violation,'' Coburn said. ''What we have today is intolerable, but to not fix it right is absolutely intolerable. When we tell people more of the status quo, where people will not get the care they need, and not to have a major - I'm talking major - reorganization in the way we deliver health care to tribal citizens in this country, that gives flexibility, opportunity and choice, that puts them on a par with everybody else in this country, rather than to give them second- and third-tier care, I will continue to hold things.''

Yet another view came from Sen. Craig Thomas, R-Wyo., committee vice chairman, who cautioned against delivering a harsh judgment of Indian health care generally. ''We need to make sure we do the best we can, but I hope we aren't overly critical as to what we have.'' At least in Wyoming's Indian communities, he said, ''it's some pretty good health care.''

Acknowledging that cooperation will be required for the bill to become law, Dorgan asked for it from Coburn, other Senate colleagues, HHS, the DOJ and the Bush administration.

Then he returned to the theme of crisis with the story of a young Indian girl whose father and sister committed suicide and whose mother was drug-dependent. ''So this young girl just falls out of the view of people and lays in bed for 90 days, misses school and finally takes her own life.'' She was 14.

''I went to the reservation and talked to the tribal leaders, talked to the school officials, talked to her extended family. What I found is exactly what I found elsewhere [in Indian country]. Wasn't the ghost of a chance of this young girl getting the psychological help she needed. Wasn't even a car to drive her to a clinic had there been a clinic to provide the professional resources. ... Indian kids have 10 times the rate of suicide as the national average in the northern Great Plains. Six hundred percent higher tuberculosis rates. Five hundred percent higher alcoholism rates.''

He added that he has been heartened by some of the progress made in preventive health care for Indians, and went out of his way to applaud the professionals of the IHS and the Public Health Service. But he described the system of Indian health care as ''woefully short,'' on balance, of the necessities.

''I just think we've got a huge hill to climb here to address these unbelievable problems. And the victims, kids like Avis Little Wind, who felt hopeless and helpless and took her life, their memories cry out for us to do something. And as Senator Coburn said, let's not just do something and say it's good enough, let's do something that works.''

Charles Grim, director of the IHS, agreed to work with committee members to implement innovative health care models from the private sector, of a kind Dorgan has promoted since the opening bell of the 110th Congress - IHS clinics with flexible hours, open around the clock and staffed by nurse practitioners with diagnostic capabilities.

Thomas led the questioning that ultimately exposed the genesis of the DOJ white paper that led to the reauthorization's failure, following the November 2006 congressional elections. The white paper raised concerns that the bill would be interpreted as ''race-based'' by the courts, and went further to question the federal obligation for Indian health care. After further tough questioning from Dorgan, and with the benefit of a March 14 hearing on the IHCIA reauthorization in the House of Representatives, the following scenario emerged: a DOJ staff member, described as ''self-interested'' in the House by Natural Resources Chairman Rep. Nick Rahall, D-W.Va., circulated the white paper to the Republican caucus in the Senate; several senators responded by placing holds on the bill; the DOJ resolved its concerns to the point of supporting a substitute reauthorization bill introduced only hours before the close of the 109th Congress; Dorgan supported the bill in deference to McCain, then committee chairman, but also inserted his objections to the late version of the bill into the Congressional Record; and the whole exercise had the desired effect of destroying the bill's chances without admitting that any particular person or party had deliberately done so.