Editorial: Health care costs rising in prisons


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Between the recent glitches in the government health insurance website and long-running debates on how to fund federal entitlement programs such as Social Security and Medicare, health care is a topic that has been at the forefront of the American Zeitgeist for decades.

But one aspect of care has fallen quietly under the radar, even as costs have risen: inmate health care.

A report released in October by Pew Charitable Trusts studied 44 states and found health-care costs for prison inmates rose in 42 of those states, with a median growth of 52 percent from 2001 to 2008. In Iowa, costs rose by 39 percent in per-inmate spending.

The causes of this climb are easy to see and are pointed out by the report. One reason for the cost increase is, to put it simply, population increase. Over the period of study, the number of prisoners in correctional facilities rose by 15 percent, part of a long-term trend.

The number of Americans in prison nearly tripled from 1987 to 2007, due partially to the proliferation of mandatory minimum sentencing and the war on drugs. Since 1998, the single largest driving force behind rising inmate numbers in federal prisons is longer sentences for drug offenders.

Prison costs as a whole have gone up with this rising population, and they will continue to do so. By 2020, federal prison costs are expected to rise to 30 percent of the Department of Justice’s budget.

Other possible causes for the cost increase outlined in the report include an aging prison population, the lack of nearby facilities for health care, and the prevalence of mental-health and substance-abuse issues among inmates.

Most of these factors won’t be easy to fix. The very things driving up costs require more funding to solve, and a proposal to increase taxes to pay for more prison expenditures would be political suicide.

However, some states have had relative success in utilizing cost-cutting measures for prison health care. The practice of telehealth, the use of electronic information and telecommunications technologies to support long-distance clinical health care, is a cheap and relatively effective way to bring treatment to inmates that may not have access to quality facilities. Some states have also outsourced medical care to public universities. This seems to be a good fit for the University of Iowa Hospitals and Clinics, which provides care for some inmates.

Unfortunately, the fact of the matter is that costs will continue to remain high as long as prison populations increase or stay stagnant. There are only so many ways to cut costs and still maintain a basic level of care, and methods of treatment such as telehealth should be looked at as a way to help relieve some of the symptoms of prison costs, not a remedy for the problem itself.

The good news is that inmate numbers have begun to swing the other way as states implement reforms in the corrections system. The Bureau of Justice Statistics recently announced a 2.1 percent drop in the number of inmates at state prisons, continuing a three-year downward trend. Yet the United States still has a ways to go compared with other nations. Even though America has only 5 percent of the world’s population, our prisons contain 25 percent of the world’s inmates.

In order to combat its 39 percent increase in inmate health-care spending, Iowa prisons should take advantage of the measures outlined in the report for a quick way to reduce costs. But for a long-term solution, lawmakers should look at ways to further reduce inmate populations and ensure that the focus of prisons is on rehabilitation, not punishment for punishment’s sake.

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