The cost of health care for prison populations

Great Debates
21

To me it really depends on which criminals we’re talking about – and I can understand why you, QtM, don’t draw distinctions, but your role is rather unusual.

But push your argument to its extreme – say some roofing contractor who’d worked on your house for a week, been paid and gone about his business, decided a month later that he was really attracted to your child. He knows your schedule and the layout of your house. He abducts, rapes and murders your kid. Is caught and sentenced to life without parole, gets one of those sentences where “life MEANS life” because he’s a career criminal who’s been violent towards children in the past.

Five years later he needs - what? - a transplant? Treatment for prostate cancer?

You honestly want to prolong his life? To support (as a taxpayer) the extension of his existence? Why? He’s not doing anything all day, he’s there because he’s a wretch of a human being, and he’s supposed to remain in prison until he dies. Let him out, and he’ll do it again.

The other thing is, since when do we have unlimited money in this country? Shouldn’t we invest wisely, in people for whom there is a future, or towards whom there is an obligation?

I completely agree that people who’ve committed minor crimes and children who’ve gotten off to a bad start in life are generally worth investing in; I’m all for helping them make a new life. And the “pedophile” label is sometimes applied inappropriately - an adult who dated a 16-yr-old is not the same as the rapist of a 6-yr-old.

But these violent criminals who prey on children and random co-eds, they’ve got to go.

22

A couple of days ago, I started this thread , asking for personal anecodotes about vicious criminals. Lots of interesting stories.

I recognize that our empathy and compassion are a good thing; I just think humanity is wasted on the inhumane. We are NOT all the same.

23

[QUOTE=fessie]
Five years later he needs - what? - a transplant? Treatment for prostate cancer?

You honestly want to prolong his life? To support (as a taxpayer) the extension of his existence? Why? He’s not doing anything all day, he’s there because he’s a wretch of a human being, and he’s supposed to remain in prison until he dies. Let him out, and he’ll do it again.
[/QUOTE]
Someone who would do that deserves to die in the most horrible way: I would wish an agonizing cancerous end upon him (I’m not QtM, of course.)

However, not only do we have this pesky constitutional prohibition on it, but I don’t believe the world is epistemologically certain enough to visit death and ruin upon people based on an outcome from our criminal “justice” system. Too many mistakes are made to tolerate killing and torturing people.

24

[QUOTE=fessie]
…But these violent criminals who prey on children and random co-eds, they’ve got to go.
[/QUOTE]

Let’s raise your extreme up a step to reality. Let’s say a guy is convicted for rape, gets prostate cancer and according to you, he shouldn’t get the treatment that us decent folk get; because he’s a raping scumbag; that’s your stance, yes?

Of course he claims to be innocent, but we have an eyewitness and we all know that criminals lie all the time…he does 18 years and he gets a DNA test and turns out he was innocent…oops.

Will sorry be enough, not only as he lost 18 years, but is now riddled with cancer? What’s our obligation as taxpapers now? What’s our obligation as decent folk? How do we make it right, now?

DNA Clears Man

The criminal justice system sufferes from human error and until we can prove guilt beyond a reasonable doubt; I won’t deny them medical treatment, nor their lives.

I would rather pay for a hundred people to receive medical treatment who “have to go”, than have one innocent person suffer more than they have to…bad enough we took their freedom, that was a mistake; denying them certain medical treatment wouldn’t be and saying ‘sorry’ wouldn’t be enough; if we’re wrong.

At least I don’t think it should be…YMMV, of course.

25

[QUOTE=Qadgop the Mercotan]
I’ll also leave Corrections Medicine at that time, and good luck finding docs and nurses willing to give state-sanctioned less than the medically necessary care to inmates. That would certainly stain my soul, and I won’t do it.

QtM, physician to felons.
[/QUOTE]

I respect your position, and I think it’s good that you’re working where you are.

Thousands of doctors and nurses have to provide less than optimal care every day to free citizens who can’t afford the best, or even “medically necessary” care, and I’m sure it pains them deeply every day.

We’re all keeping our fingers crossed this winter for WhyBaby’s health, washing our hands a lot and not going out much, as we simply cannot affort the RSV immunizations. As a micropreemie weighing less than 20 pounds before her second birthday, she should get them, she’s under the official recomendation guidelines. But we simply cannot afford the shots, which cost a bit over $1000 each month from October to April. Our insurance won’t cover it, and we maxed out our credit to get them last year when it was even more critical. I know her doctor wishes she could just give her the shots - but who’s going to pay for it? No one, that’s who.

26

[QUOTE=TokyoPlayer]
I can see several thousand dollars a shot for something once a month, but 10 a day? (Do the math.) I’m still saying no way to **Lissa’s ** story.
[/QUOTE]

Maybe Qadgop the Mercotan will be able to help.

My husband is not a doctor. He was the chief supervisor of the medical area, but that doesn’t mean he has as much medical knowledge as a doctor. He had to rely on the knowledge of medical professionals when making his decisions. He couldn’t justify that kind of expense to the warden and the central office if the treatment wasn’t medically necessary.

I do know that our state doesn’t do transplants.

27

That’s a fair argument, holmes.

I’d be interested to hear how common it is, though, for the wrong person to be convicted of an extraordinarily heinous crime. And as forensic science continues to advance, shouldn’t we be getting closer to accurate convictions?

“Expedited Life, with Limited Care” seems like an appropriate sentence for certain extraordinary people. You’re absolutely correct, though; deciding who those people are should be a laborious process.

28

[QUOTE=fessie]
That’s a fair argument, holmes.

I’d be interested to hear how common it is, though, for the wrong person to be convicted of an extraordinarily heinous crime. And as forensic science continues to advance, shouldn’t we be getting closer to accurate convictions?
[/QUOTE]

All I can say is I did a quick Google and was overwhelmed by the amount of cases. I leave it up to you to decide how common it is.

29

[QUOTE=fessie]
That’s a fair argument, holmes.

I’d be interested to hear how common it is, though, for the wrong person to be convicted of an extraordinarily heinous crime. And as forensic science continues to advance, shouldn’t we be getting closer to accurate convictions?

“Expedited Life, with Limited Care” seems like an appropriate sentence for certain extraordinary people. You’re absolutely correct, though; deciding who those people are should be a laborious process.
[/QUOTE]

It shouldn’t matter. If they didn’t get a death sentence then by denying them proper care, we are in fact sentencing them to death. Prisoners are considered wards of the state and as such the state has a duty.

I think that the real shame is that the average citizen doesn’t have access to affordable health care.

30

[QUOTE=Caffeine.addict]
It shouldn’t matter. If they didn’t get a death sentence then by denying them proper care, we are in fact sentencing them to death.
[/QUOTE]

Depends on whose “proper care” you’re referring to - members of Congress, people subscribing to WhyNot’s health insurance, or the employed-yet-uninsured.

Cripes’ sake - when all this was hammered out 200+ years ago, nobody would’ve dreamed we’d have the ability to treat people for just about every ailment under the sun. Just because it’s possible to treat a disease doesn’t mean it has to happen.

31

[QUOTE=fessie]

I recognize that our empathy and compassion are a good thing; I just think humanity is wasted on the inhumane. We are NOT all the same.
[/QUOTE]

Admittedly we are not all the same, but your constitution and many other modern statements of rights lay down basic rights for everyone. Some go so far as to create a right to medical treatment for everyone.

If we are reduced to deciding from whom we should rfemove basic human rights, then we have no reason to claim that we have any compassion, empathy and humanity at all.

Individuals and societies may be easily judged by how they treat their most despised members. Count me in the group that believes that even the most despised should retain all their basic human rights. If you wish to deny basic human rights to a sub-group that you despise, I am afraid that this says more about you than it does about “them”.

32

[QUOTE=WhyNot]
I respect your position, and I think it’s good that you’re working where you are.

Thousands of doctors and nurses have to provide less than optimal care every day to free citizens who can’t afford the best, or even “medically necessary” care, and I’m sure it pains them deeply every day.

We’re all keeping our fingers crossed this winter for WhyBaby’s health, washing our hands a lot and not going out much, as we simply cannot affort the RSV immunizations. As a micropreemie weighing less than 20 pounds before her second birthday, she should get them, she’s under the official recomendation guidelines. But we simply cannot afford the shots, which cost a bit over $1000 each month from October to April. Our insurance won’t cover it, and we maxed out our credit to get them last year when it was even more critical. I know her doctor wishes she could just give her the shots - but who’s going to pay for it? No one, that’s who.
[/QUOTE]

Yes, Health Care in the USA needs a serious overhaul. It is a damn shame that your family & so many others suffer because you can’t afford certain treatments. But caring for the needs of prisoners is NOT the cause of your problem.

Some of those who want to sift through humanity & decide who is worthy of decent health care would include micro-preemies among those that “society” should not protect. “Treatment is so expensive & many of them suffer long-term health problems.”

Let me emphasize that I am NOT one of the Judges.

33

[QUOTE=fessie]
Cripes’ sake - when all this was hammered out 200+ years ago, nobody would’ve dreamed we’d have the ability to treat people for just about every ailment under the sun. Just because it’s possible to treat a disease doesn’t mean it has to happen.
[/QUOTE]

That is the whole benefit and whole problem with creating “Rights”. They are created as absolutes without the chance of them being abrogated by mob-rule or personal distaste. The right to medical care when a ward of the state has been developed through your own courts interpreting your own constitution. There is a remedy- amend the constitution, but be careful that you don’t throw the baby out with the bath water.

34

[QUOTE=Pjen]
If we are reduced to deciding from whom we should remove basic human rights, then we have no reason to claim that we have any compassion, empathy and humanity at all…If you wish to deny basic human rights to a sub-group that you despise, I am afraid that this says more about you than it does about “them”.
[/QUOTE]

How does that follow? Why the insistence on absolutes and simplification?

Human behavior isn’t black-and-white; we’re on a bell curve, with saints and devils at either end, and the vast majority of us somewhere in between.

If you want to make this personal, about me, then I have a right to ask about you – do you suppose, when considering truly heinous criminals, that “there but for the grace of God go I”? Because I do not; I’m somewhere in the middle of the curve, with the capaicty for good and bad. But that malicious, evil shit is NOT mine and I won’t claim it.

You state that I have no compassion, empathy or humanity? Hardly.

35

[QUOTE=Bridget Burke]
Yes, Health Care in the USA needs a serious overhaul. It is a damn shame that your family & so many others suffer because you can’t afford certain treatments. But caring for the needs of prisoners is NOT the cause of your problem.

Some of those who want to sift through humanity & decide who is worthy of decent health care would include micro-preemies among those that “society” should not protect. “Treatment is so expensive & many of them suffer long-term health problems.”

Let me emphasize that I am NOT one of the Judges.
[/QUOTE]

Oh, I get that, absolutely. My point, which I didn’t make very clearly, is that **Qadop **is one of the few doctors who CAN provide the best care for all of his patients, where most doctors are forced to provide suboptimal care because of cost constraints. His assertion that everyone would quit prison care if we limited (not eliminated, but limited) medical choices for prisoners strikes me as a bit niave, because the vast majority of medical professionals are already in a situation where they cannot provide the medical care they should to many of their patients.

But, yeah, of course the Mama part of me thinks my precious innocent baby girl is more “worthy” of the limited health care dollar than some unequivacably evil multiple homocide criminal who’s only a few years from death anyway! But if it helps remove the preemie part of the equation, my 13 year old has acne that we’re treating with OTC meds because the prescriptions his doctor gave us are over $200 a month, and we can’t afford those either. Since it’s not a life-threatening condition, it gets pushed to the “best we can afford” instead of “the best care possible.”

Again, my point of view isn’t that criminals don’t deserve good medical care, it’s that we ALL deserve good medical care. I’m convinced that it can better be achieved by a national health care system than by private companies making phenominal profits while individuals choose whether Grandma can get her blood pressure medication or pay her rent this month. Such a system could provide good care to both criminals and the rest of us, and make this whole debate moot. I don’t think anyone would complain about criminal care if we all had the same care. (Maybe I’m wrong about that. Maybe some people really would like to let criminals suffer and die anyway. I’m not one of them.)

36

[QUOTE=fessie]

If you want to make this personal, about me, then I have a right to ask about you – do you suppose, when considering truly heinous criminals, that “there but for the grace of God go I”? Because I do not; I’m somewhere in the middle of the curve, with the capaicty for good and bad. But that malicious, evil shit is NOT mine and I won’t claim it.
[/QUOTE]

I often work with the very people you despise.

And, yes, I do operate the mantra, “there but for the Grace of God go I” though in a purely non-religious manner.

I sincerely believe that when it comes to basic human rights, these are as applicable (and maybe even more so) to the despised of society as to the prized by the society. I have never met or worked with any person who does not have an element of basic humanity that should be valued and glorified, however heinous their crime. That is what, to me, compassion, empathy and humanity is all about. It is certainly not about casting out peopel and denying them basic rights.

I work very hard teaching people who have chosen or have been forced by circumstance to work with the most despised in society and I work on programs which are designed to ensure that people in that position ensure that basic human rights (and other necessary societal goods) are provided to the most lowly. Many people come to realize that working in this manner is rewarding in that it emphasises and magnifies their compassion and empathy and which raises their claim to humanity above the common and general.

37

[QUOTE=Lissa]
An inmate is a “ward of the state” meaning that the state has a duty to care for their health and well-being. The courts have determined that this includes medical treatment. Different states have different standards for this. My state is sort of a middle-of-the-road state. We do what’s necessary to preserve life but every inmate does not get the latest and best treatments.

You’ll get no argument from me that it’s sad that ordinary citizens are left to fend for themselves, but I disagree that we should reduce the care for inmates as a way to make things “fair.” Instead, we should work together to ensure that everyone has health care.
[/QUOTE]

I agree, but I also think that you or I deserve free health care before someone who is incarcerated. If it is cruel or unusual to deny a sick person expensive medical treatment, there is a hell of a lot of cruelty out there. I am completely uneducated about the prison system, so I don’t know if they (lifers or otherwise) sit around and waste the state’s money or participate in labor programs to earn money for their keep. Is this so, or is this also considered cruel and unusual?

38

[QUOTE=WhyNot]
Oh, I get that, absolutely. My point, which I didn’t make very clearly, is that **Qadop **is one of the few doctors who CAN provide the best care for all of his patients, where most doctors are forced to provide suboptimal care because of cost constraints. His assertion that everyone would quit prison care if we limited (not eliminated, but limited) medical choices for prisoners strikes me as a bit niave, because the vast majority of medical professionals are already in a situation where they cannot provide the medical care they should to many of their patients.
[/QUOTE]

Oh, my naivete was burned out of me long, long ago. I’m familiar with the frustrations of cost-containment, non-formulary drugs, procedure denial, etc. in private practice. But frankly, whenever it could be demonstrated that what was being denied was a part of The Standard of Care, the denial could usually be overturned. Now, many things get requested that aren’t the standard of care, and people can still get quite upset about that when such is denied. Long-shot treatments with no record of success for fatal illnesses, unproven meds for chronic diseases, experimental protocols that cost thousands to carry out, drugs only available in foreign countries, I’ve seen all these submitted for insurance payment.

The standard of care for every failing heart, liver, or kidney is not a transplant. Those are options in a few select situations and patients. Likewise for many common therapies for diabetes or heart disease. My inmate diabetics should be able to get regular eye and foot exams, and the diets, medications, and education necessary to properly care for their diabetes. They rarely need insulin pumps, islet cell transplants, inhalable insulin, and they certainly never need chelation!

You may find licensed docs and nurses to work in places where asthmatics only get a rescue medicine like albuterol to help them breath, and not the maintenance meds to keep them free of asthma attacks in the first place. But I doubt you’d find many good docs and nurses willing to do that. At least not for long. Watching people suffer even if they are deserving of it will scar a person badly. Intentionally making them suffer does even worse.

39

[QUOTE=The Octagon]
If it is cruel or unusual to deny a sick person expensive medical treatment
[/QUOTE]

The argument runs that the incarcerated person is denied the opportunity to try to obtain said medical treatment for himself. Since the state won’t let him hold a job with good benefits which might have let him do that, the state must provide.

I agree there is a dichotomy, and a bitter irony that inmates get better access to care than many, many children and law abiding folks. But I’m not sure how to solve that particular riddle.

40

[QUOTE=Lissa]
Maybe Qadgop the Mercotan will be able to help.
[/QUOTE]

Maybe. We’ll see.

I don’t see too many figures in dollars and cents. They may have kicked me up into the management ranks, but they still don’t let me handle money. But we have had inmates who needed medications running $40,000/month, and needed delivery systems to dose them with it constantly and these systems and their maintenance often cost just as much as the medication. Throw in the full-time nursing care needed in the prison infirmary at $14,000 a month, the occasional trips to the specialists and the various surgeries where their anatomy was forceabley rearranged, and you have someone who’s cost you over a million dollars in a year.

Same with transplants that don’t go so well, like liver transplants. The state has coughed up a couple million to keep an inmate going in the Intensive Care unit for 6 months before. And it’s a slippery slope. Once you’ve headed down that path, it’s hard to suddenly say “stop! no more!” if the patient or their guardian don’t agree.