Dying on our dime

Last Sunday's Los Angeles Times Magazine featured a cover story titled "Dying on our dime". The article was about the growing population of older inmates in the California prison system and their staggering medical costs. It was a very interesting article. It uses an example of an 82 year old prisoner who needs kidney dialysis every day, which costs about $436k a year to provide.

The article goes on to suggest that the three-strikes-and-you're-out policies of late are going to cost staggering amounts of money as these three-strike prisoners age behind walls. It asks the reader to question to wisdom of that sentencing policy and its impact on their pocket book. It also suggests that older convicts are no longer a threat and should therefore be released.

I'm mentioning this article in my blog because I feel that it totally misses the point. The journalist who wrote this is failing to step back and look at the macro-economic picture. She does not address the question of who is going to pay for their medical care if they were not in prison?

The answer is Medicare (MediCal specifically). If they are old enough to be eligible for Medicare coverage, then that is what is going to pay their medical bills. Medicare is tax payer funded, just the like the prisons. The bottom line is, the taxpayers are going to have to pay for it no matter if the convict is in or out of prison.

So that makes the whole point of the article moot. The only question, and the real crime, is why does the CDC (Calif. Dept. of Corrections) allow themselves to be billed that much for what should be routine medical care?

The answer, I feel, is that the CDC does not want to fulfill its mission of providing medical care for its inmates. I think that they have embarked on a strategy of performing their duties so poorly that the state will have no choice but to take the job, and hence the responsibility, away from them. If they pay outrageous fees for poor service, the public, courts, and politicians will eventually demand reform.

I am not clear about the eligibility of inmates to receive Medicare benefits. Are they excluded from Medicare as long as they are imprisoned? If so, then California should demand that Medicare contribute to the medical expenses of elderly inmates

The solution is for California to demand that the CDC fulfill it's charter and come up with an effective solution for this. They know there is going to be a growing demand for aged medical care. They must bring the care to the inmates rather than paying the extra expense of bringing more and more inmates to the care (as in the example given). If they know they are going to have a lot of inmates who need dialysis, then bring the dialysis to them. Put the inmates with common medical needs together so that medical services can be delivered efficiently and cheaply.

For example, they could build an aged-care nursing home within a prison. They could build a CDC hospital next to a state medical school to give inmates in their custody close access to more advanced medical care. Rather than paying extra guards to drive these people all over.

Also, the state is going to have to recognize that the CDC nursing homes and hospital are going to have to be located in the urban areas and not stuck out in the middle of nowhere. They have to be closer to the medical and human resources that are needed to provide medical care. The closed Marine Air Base at Tustin in Orange County would have been perfect. Part of March AFB in Riverside would be good. The Mare Island Naval Station in Contra Costa would be good.

Doing this will go a long way towards detaching the issue of inmate health from the issues of justice, punishment, and reform.