HEALTH CARE for many Native Americans in this country sinks to Third World levels. According to a draft report by the U.S. Commission on Civil Rights, deaths from alcoholism are 770 percent more likely among Native Americans than the general population; from tuberculosis, 650 percent; and from diabetes, 420 percent. In some tribes, one in two people suffer from diabetes. The Indian Health Service, primary health care provider for more than 1.6 million members of federally recognized tribes, is so underfunded that it spends only $1,914 per patient per year, about half of what the government spends on prisoners ($3,803) and far below what is spent on the average American ($5,065). Funding is so low that to be transferred out of an IHS facility for specialized treatment a patient must be in danger of losing a life or limb.

The Bush administration and Congress could help, but they have been sitting for almost four years on a revamped Indian Health Care Improvement Act. The original bill, enacted in 1976, is the cornerstone law that directs health care resources to Native Americans; it expired in 2001. Congress has been appropriating money year to year since then, but the strategy for providing health care for Native Americans is in dire need of a wholesale update, which the neglected bill would provide. Developed by tribal leaders themselves for the first time, the legislation would authorize Congress, among other things, to help Indian reservations recruit health professionals and specialists, expand preventive and behavioral health programs -- an important step in helping to combat alcoholism -- and give tribes more say in decision making. But only after long delay did Tommy Thompson, secretary of health and human services, finally agree last month to make this act a priority and work with congressional staffers to iron out remaining issues. Mr. Thompson and Congress should be kept to their promise of passing this legislation before the end of this session.

As important as authorizing the act is making sure there's money to pay for these programs, and Congress has done an abysmal job at that. The administration says it would support an increase in funds to match medical inflation, but that would only lock in the present inadequacies; Sen. Thomas A. Daschle (D-S.D.) has proposed a more substantial and appropriate increase. The federal government is bound by treaty to provide for Indian health, and it is failing. This is an obligation the nation has shirked for too long.