Health Care/Joan Retsinas

Prisoners: The Fiscal Boomerang

“Lock ‘em up!” “Throw away the key!” The mantra of law-and-order politicians, bolstered by their constituents, propelled an influx of men into prison. In a zeal to “lock ’em up,” we saw the advent of mandatory sentencing, stiff minimums, and “three strikes you are out.” Even when judges demurred, the guidelines propelled them to toughen up. And state courts followed the federal lead, imposing longer sentences than in the softer-on-crime past.

We have jailed people, with no real possibility of parole in their lifetimes, who got embroiled in buying, selling, or using drugs, especially cocaine and crack. Could the inmates have outgrown their addictions? Could they have matured beyond joy-riding thrills, especially those plunked into prison in their twenties? Could they have learned skills? Re-entered society to live inconspicuously? We don’t know, because we shut the doors quickly, for sentences that would last most of their adult lifetimes. Added to those felons, we have imprisoned the people who commit heinous crimes. We want the serial rapists, the bombers, the assassins off our streets. We have put a lot of Americans “behind bars,” figuratively throwing away the key.

Fast forward twenty, thirty years. The motorcyclist/drug mule might need hip replacement surgery. Or cataract surgery. He may have Alzheimer’s or kidney failure. The only malady that inmates avoid is skin cancer: inmates rarely go outside. They don’t go to the beach, play golf, or ride motorcycles. But they develop all the other chronic diseases of senescence: diabetes, arthritis, coronary disease – as well as the array of cancers, including lung cancer. (Although most prisons are smoke-free indoors, many allow smoking outdoors.) The Washington Post (May 3, 2015, “The Painful Price of Aging in Prison,” by Sari Horowitz) documents the increase: in 2000, 6.4% of the federal prison population was older than age 55; by 2014, the number had jumped to 10.6%. The proportion will rise over time. Not surprisingly, some prisons have morphed into quasi nursing homes. Forget Clint Eastwood’s “Escape from Alcatraz”: some prisoners navigate in walkers. Some shoot up, but with insulin, not heroin. Some have regular dialysis sessions. Some can’t remember their pasts, let alone their crimes.

For the government, the aging prison population looms as a fiscal crisis. The Washington Post reports that from 2006 to 2013, the budget for health care at the federal Bureau of Prisons soared 55 percent, to reach $1 billion. The media have reported the soaring costs of Sovaldi, the $84,000 treatment for hepatitis; but the cost of elderly prisoners who need care is just as frightening, if only because their numbers are mounting.

The challenge is to figure out what to do with these ill prisoners. Speed them out of prison on grounds of clemency? President Obama has opened the door for drug inmates who have served at least 10 years to leave; but the process demands a case-by-case review. Once released, do they go to families who long ago lost touch? Do they go to nursing homes – transferring the cost of their care from Corrections to Medicaid? Do they end up homeless? We know from the era of “de-institutionalization” that patients with mental illness, released from hospitals, too often ended up on the streets. Inmates with multiple diagnoses, released after 20 years behind bars, might follow the same route.

The “lock ‘em up” fervor that still inflames political rhetoric has proven to be a humanitarian tragedy. Some of these prisoners might have contributed to society. Even President Clinton, who in 1994 took credit for pushing a bill that added longer sentences and more prison cells, recently regretted his zeal, largely because so many young black men ended up behind bars. Instead of spending so much money to incarcerate so many men for so long, Clinton conceded we might have spent more on rehabilitation. (US Reuters, May 6, 2015 “Bill Clinton says tough ‘90s crime bill went too far)

Beyond the humanitarian crisis, though, that fervor launched a fiscal boomerang, pushing up prisons’ soaring healthcare budgets. For the sake of justice, we should rethink our zeal to throw away the key. For the sake of taxpayers, we should also rethink our zeal. In throwing away the key, we risk throwing away our money.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, June 15, 2015

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