Introduction
Prison overcrowding has become a massive problem in the United States in recent years. According to the Federal Bureau of Prisons, there are well over 200,000 inmates incarcerated in federal penitentiaries, camps, and other related institutions. This is excluding the female inmate population, which is housed in separate penitentiaries. Additionally, there are countless military, state, and ICE (Immigration and Customs Enforcement) facilities across the country, ballooning America’s inmate population to heights unheard of in the Western world. In total, there are nearly 1,700 correctional facilities, including privately-owned penitentiaries. When you add in individuals who are on probation or parole, the number of people under the jurisdiction of the justice system becomes even larger. As a result, America has the largest prison population in the world, larger than Cuba’s, Russia’s or China’s (Bureau of Justice Statistics, 2013). Indeed, some advocacy groups claim that there are more people imprisoned in the modern U.S. then there were in the gulags of Stalin’s U.S.S.R.
Specific statistics on the rate of incarceration in the U.S. vary, but it is generally accepted that the U.S. has approximately 716-760 prisoners per 100,000 citizens. As recently as thirty years ago, that number was barely a fifth of what it is today. The increased emphasis that states and the federal government have placed on law enforcement–in the form of the War on Drugs (and the crack cocaine sentencing disparity), the preponderance of “Three Strikes” laws and massive increases in illegal immigration–are generally accepted as reasons why the national prison population has exploded in the past few decades.
Ultimately, the continued growth in the U.S.’ inmate population has strained resources at every level of government. According to watchdog groups, the federal government has been perpetually unable to cope with the continual increase in the prison population, even as prison and correctional facilities continue to be expanded and new ones built (Government Accountability Office, 2012). The consequences of this include an increase in prison violence (both between inmates and against guards and other employees), overcrowding in many facilities, and most importantly, a decreased ability to rehabilitate prisoners and make them into lawful members of society. Projections indicate that inmate population growth will continue to outstrip the government’s ability to house and provide resources to said inmates, which will likely lead to further overcrowding as well as exploding recidivism rates.
Put simply, this situation represents a crisis for the American justice system. In particular, the straining of correctional facility resources to their breaking point will have repercussions in the ability of prisons to provide medical services to inmates. Ultimately, wardens, correctional officers and other prison personnel will have to make difficult choices about how to care for the inmates under their protection. With incarceration costs rising across the board, budgets will be strained to their limits, which if not handled in a sensitive fashion will result in a declining quality of life in American prisons, potentially endangering the welfare of inmates and inflicting cruel and unusual punishment on them. In order to maintain quality standards at American correctional facilities, administrators will need to creatively allocate their increasingly limited budgets in order to best serve the inmates under their care.
The Problem of Medical Costs
Without a doubt, medical costs happen to be one of the biggest problems facing American correctional facilities. With the rise of Three Strikes laws and the War on Drugs, a wider variety of Americans are being imprisoned, and a greater number of them are being imprisoned for longer periods, including life sentences. The abolition of the death penalty in many states has also lead to an uptick in the long-term prison population. When inmates are held for decades or more, their medical problems become problems for the justice system; without freedom or their own money to pay for health insurance, the justice system must assume the costs of keeping them alive and in reasonably good health. Kidney failure, heart attacks, strokes, cancer: as the long-term inmate population continues to grow, the justice system has to pick up the costs of dealing with these life-threatening and expensive-to-treat conditions. Additionally, overcrowding and resource limitations place an additional burden on inmates’ well-being. With the increase in prisoner-on-prisoner violence and sexual assault, correctional facilities find themselves having to deal with the aftermath of these brutal confrontations. As overcrowding grows, medical costs are only expected to grow along with it.
Statistics from prisons across the country show how desperate the situation has become for many. In Minnesota, ballooning inmate medical costs have become a flashpoint for voter angst, as the costs of providing life-saving health procedures to the incarcerated falls to the taxpayer. In 2010, Ramsey County (home of St. Paul, the state capital) had to pay nearly $500,000 for emergency care for just two inmates, which nearly forced the county to declare bankruptcy (Havens & Anderson, 2011). Neighboring Hennepin County (home of Minneapolis) was forced to purchase dialysis machines for its prisons to cut transportation and hospital costs. Total costs for inmate medical care in Hennepin County in 2009 were $4.8 million, nearly 15 percent of the budget.
At the same time that prisoner medical costs are threatening to break the budgets of numerous state and county facilities, some states go in the opposite direction of providing too many services, more services than regular citizens can receive and at a faster rate. For example, California state prisons provide inmates with complementary dental and physical examinations, along with tests for various ailments and sexually transmitted diseases such as HIV and tuberculosis (Shalit & Lewin, 2004). It could take an ordinary citizen up to six months to receive those kinds of treatments, and at a considerably higher cost. Indeed, in some parts of the U.S., people have been caught committing petty crimes solely in the hopes of getting incarcerated and receiving free medical care. These incidents are threatening to comprise the efficiency of the entire justice system.
Potential Solutions
Any attempt to alleviate this crisis needs to take into consideration the need to maintain a humane standard of living for American inmates. Ultimately, providing basic medical coverage, including care for life-threatening ailments, is one of the necessary functions of penitentiaries and county jails. A number of potential solutions have been found that can reduce medical costs while maintaining this humane standard.
A number of Minnesota counties have experimented with various solutions to reduce their inmate medical costs. In Dakota County, inmate healthcare costs have decreased nearly $200,000 in three years due in part to the county switching to a mail-order pharmacy to provide medication, as well as a change in Minnesota state law that gives counties a discount when it comes to medical bills (Havens & Anderson, 2011). Hennepin County, as mentioned earlier, has purchased X-ray and dialysis equipment to cut down on the necessity of transporting inmates to hospitals (and paying overtime to the guards that are required to go with them). While medical costs remain a problem for Minnesota jails and prisons, these solutions have helped to mitigate the worst aspects of this crisis.
Across the country, prisons and jails are seeking to make deals with local hospitals and healthcare providers for discounts. Carbon County, Pennsylvania has seen tens of thousands of dollars worth of inmate medical costs defrayed due to the discounts it has acquired from area medical providers (Fulton, 2006). Additionally, centralizing medical budgets under state government may assist in planning for the future. A study of medical care in prisons across New York state revealed a wide disparity in quality from prison to prison, depending on local county budgets and availability (Shalev et al., 2011). Placing medical budgeting in the state government’s hands would allow for a more equitable distribution of medical care in state penitentiaries, particularly in New York City-area facilities which are constantly dealing with budget shortfalls (Shalev, 2009).
Finally, another simple way to cut medical costs would be to reduce the number of unnecessary procedures. In the specific case of California, there is little reason why prisons should be providing such thorough and specialized checkups to inmates, especially when actual, taxpaying citizens cannot access the same level of care so easily (Shalit & Lewin, 2004). The necessity of gauging an inmate’s health upon incarceration is obviously necessary; however, giving every inmate an HIV test seems extraordinarily wasteful. Specialized procedures should be limited to those who are likely to need them (for example, HIV tests should only be administered to confirmed intravenous drug users and other high-risk groups).
Conclusion and Recapitulation
These solutions will not solve the crisis of inmate medical care costs overnight. The problems of overcrowding and resource limitation have only gotten worse in recent years, and will only grow as the inmate population grows. However, a more intelligent approach to inmate care costs will spare counties and states the financial pain that comes with waste. By examining these and other solutions, we can strike a middle ground between recognizing the humanity of prisoners while maintaining fiscal sanity.
