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NEWS & LETTERS, October - November 2007
Voices From the Inside Out
Health care failure
by Robert Taliaferro
One of the debates raging in Congress regards the privatization of Medicare and its components. Called "Consumer Choice," it is a poorly thought-out concept to defund Medicare programs, thus robbing millions of citizens of the right to comprehensive, affordable health coverage.
As with many social issues, if one wishes to see the long-term effects of a mismanaged bureaucracy, one needs to travel no further than one's friendly neighborhood jail or prison.
The U.S. has the highest incarceration rate in the world, approximately 740 people per 100,000 of the population, or roughly 2.2 to 2.5 million people currently behind bars with another 5 to 6 million on parole or probation. As shocking as those statistics are, that's only one aspect of incarceration.
In the late 1990s and early 2000s, while Congress was being lobbied by HMOs and health insurance companies to "revamp" Medicare, state and federal prisons were already revamping their systems, privatizing their health care, and thus lessening health care services and accessibility provided to prisoners.
Ironically, the theory in the state and federal prisons was that privatized care would be more professional and would help to cut costs in the growing Department of Corrections (DOC) budgets. Around that same timeframe, the U.S. was also embarking upon the largest prison-building boom in the country's history, thus exacerbating DOC operating budgets exponentially.
What many states did was cut wages for inmates, and privatize their health care access, replacing DOC hired and trained personnel with contract employees of a variety of health care providers. To help offset the costs of these new services, and to cut down on alleged "sick call slackers" in prisons, various corrections departments opted to charge their prisoners co-pays.
Co-pay is not a new concept to civilians, but at the time it was to prisoners. Civilians have insurance plans that require co-pays, which tend to be high, but at least manageable. Then, of course, a consumer does have a choice if they wish to pay the co-pay. Civilian co-pays, however, are not designed (in theory at least) to take 100% (or more) of your earnings.
In a number of states, the idea of co-pay was initially to take a minuscule amount of money from prisoners to offset their health care and to give them a taste of self-responsibility, as well as to cut down on a number of extraneous expenses incurred by prisons.
In several Midwest states the concept was taken to extremes, until high co-pays (upwards of 100% of a prisoner's salary) caused prisoners to refuse to seek treatment because it would require them to choose between soap and stamps versus checking to see if long-term indigestion was cancer.
Another bureaucratic irony is that inmate co-pays, alleged to help cut down prison health care costs, actually sparked even larger long-term costs because prisoners were seeking health care long after the onset of an illness, thus negating short-term approaches that could have caught an illness sooner, which would have alleviated the need for long-term, radical, and more expensive treatment.
Since most prisoners opt to not pay the high co-pays, there are now more prisoners being released with major medical problems that will ultimately subject the civilian health care system to exacerbated problems. If any governmental agency ultimately has to find the money to subsidize a problem such as prison health care (or civilian Medicare programs) when it breaks down, then one must wonder why they could not use that money, in the first place, to get it right.
In prison, though, things that should make sense are often the last things to be looked at. More often than not, things that work well are broken beyond repair, then deemed as "politically fixed," like the current political fixes being recommended for Medicare, making the poor and the elderly the disenfranchised, medical prisoners of the health care industry.
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