Prison Healthcare Needs Work

Universal Healthcare Can Help

Mar 30, 2023

Good Morning Healthcare Advocates

Thank you for reading and taking action and educating others on the need for healthcare reform. Thank you also for recommending topics to research (use the comment button below). Topics in work are rural healthcare, the hospice situation, and prison healthcare.

Prison Healthcare - Better with Universal Healthcare

Healthcare in prison is a messy, complicated business. There are often insufficient medical staff and care is not always delivered as soon as needed. There are higher levels of a variety of communicable diseases, heart disease, hypertension, cancer, behavioral health issues than in the general population. Also, prison deaths due to COVID -19 were 2.3 times greater than in the general population highlighting failures in the delivery of care in prisons. Women in prison face numerous challenges, some related to reproductive health, and they do not always receive sufficient care.

Some background material.

The 8th amendment to the US constitution prohibits cruel and unusual punishment for those that are incarcerated. Estelle v. Gamble, 429 U.S. 97 (1976) established something of a right for a prisoner to healthcare. Here is a link that describes those rights in detail for prisoners.

The ruling determined that the prison officials cannot be indifferent to the healthcare needs of prisoners. Since prisoners rely on prison authorities for healthcare, failure to provide adequate healthcare can result in pain and suffering and the “infliction of pain and suffering is inconsistent with contemporary standards of decency manifested in modern legislation” (quoting the decision).

Why it matters.

A March 2, 2023 New England Journal of Medicine article discussed the possibility that the Supreme Court might reverse this decision given their arguments for deleting the right to an abortion. The Harvard Gazette interviewed Professor Marcella Alsan, physician and economist at Harvard and Crystal Yang professor at the Harvard School of Law about their paper. Here is that interview.

When Dobbs v. Jackson Women’s Health Organization was overturned by the court, they argued by interpreting the 14th amendment as originalists (what did the original authors intend). A similar argument could be used with respect to the 8th amendment to overrule Estelle v. Gamble since evolving standards of decency were part of the Estelle decision. Some justices have already expressed their view that they would like to do that and are waiting for appropriate cases to appear at the court. This seems inordinately cruel.

The systemic issue is that there is not a minimum legal standard for healthcare for the incarcerated. If there were then we would not be having this discussion. It would only be a matter of ensuring that such a standard were implemented nationwide. Remember that if you have laws, you need enforcement and then consequences for failure to abide by those laws.

Good news, such guidance exists. The United Nations established the Nelson Mandela rules for minimal standards for the treatment of incarcerated people. Those rules specify that prisoners are to be afforded humane treatment including healthcare. Here is a link to the rules. The US could establish such rules and then create a body responsible for enforcing the standards nationwide. That would be a start.

Some European countries have done this and it has worked out well for them. These include Finland, Norway and the UK. What is special there is that prison healthcare is part of their Universal Healthcare system administered by the ministries of health, not Justice. Their view is that prison health is part of national health and they treat it as such.

There are some inroads in the US. Recently, the Center for Medicare and Medicaid Services (CMS) allowed California to use Medicaid funding to treat substance abuse in prisons.

If our healthcare system were not so fragmented by various insurance programs, Medicare, Medicaid, etc. this could be so much easier, not trivial but easier.

We can tell our officials that this can be fixed. Universal healthcare can fix it just like it has in our peer countries.

TAKE ACTION

Text SIGN PWBKCR to 50409 to tell our Senators, Congressional representatives and the President

Healthcare in prison is a mess. COVID-19 deaths are 2.3 times greater than in the general public, and you know how high they are there. Rates of hypertension, cancer and numerous communicable diseases are also way higher there.

The 1976 Estelle v. Gamble Supreme Court case determined that prisoners cannot willfully be denied healthcare. But there is no standard of care. You can fix this. I want you to implement a standard of care for prisons nationwide, like the UN Mandela rules, and create an office to be responsible for enforcing those rules.

And while we are on the subject let me point out that Universal Healthcare would help make all of this happen by ensuring that the care could be paid for. Remember that Rep. Jayapal is reintroducing her Universal Healthcare bill in May. I support it and I want you to be a vocal supporter as well.