Two correlated problems, rampant escalation of health-care costs and the lack of access to health care for many Americans, challenge long-term solutions to our health-care crisis. Historically, free markets have provided the most effective method of controlling costs. Although the current health-care system is highly competitive, it falls far short of being a truly competitive marketplace emphasizing competition around cost and quality. A health-care system based on managed competition in which the marketplace is structured to create competition on cost and quality provides great promise for regulating health costs. Erosion of health-care benefits under our current system of employer-based health insurance threatens the effectiveness of any market-based solution. The 21st Century Health Care Act combines the cost-effectiveness and universal access derived through a single revenue spigot with the power of a market approach created by managed competition.

This article examines the role of Indigenous knowledges in higher education through an exploration of internationalization at U.S. Tribal Colleges and Universities (TCUs). We affirm that examining internationalization efforts with historically marginalized and underserved populations provides an opportunity for interrogating inequitable power dynamics in knowledge construction, production, and transference vis-à-vis education and within a Western hegemonic model of modernity. Our discussion is anchored in decoloniality and Indigenous sustainable self-determination, which highlight educational initiatives that bolster Indigenous identities while addressing social, political, and environmental complications created by coloniality. Drawing from a five-year mixed-methods case study with TCUs, we offer Indigenous perspectives on place-based higher educational initiatives in relation to local and global concerns, specifically human and ecological sustainability. We propose a critical lens in Indigenous internationalization wherein Indigenous worldviews are vital responses to dominant notions of internationalization and historical limitations of education for Indigenous peoples.

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