I was making a different point.  I was talking about the overall cost.    For example: let's say that the Native hospital is able to deliver 500 babies a month at $1,000 per baby and Providence delivers 500 babies per month at $1,300 per baby.  The Native hospital might bill my insurance $10,000 or bill medicaid $8,000.  But it doesn't change the fact that they were able to deliver the babies in a cost effective manner.  They do more with less money.  Which is what needs to happen in this country.