Some tribes (Navajo Nation included) are still receiving direct health care. There's a huge hospital in Gallup, NM, as well as another in Shiprock. Health care is supplied by the federal Indian Health Services (of HHS). In no way should this be construed as "far below" most US Standards.
Other tribes have opted out of direct health care preferring to receive Title 638 funds to administer for their health care. These tribes' health care naturally varies with the way the individual tribes administer their programs.
The Navajo Nation is larger than the state of West Virginia, so the analogy of town-level government wouldn't seem to apply.
We lived on the line of Leech Lake Reservation (near Cass Lake, MN) but except for that and the Crow Reservation, the rest of our reservation experiences were in the southwest.
(IHS hospital/clinics)
Yes, they're all different; laws, customs, landscape, tribal government, etc; more than most people might imagine.
