From “derivatives” to “Depends,” Madison Avenue is ready to usher a huge portion of productive America into the good life that we have all worked to finally enjoy. That is, of course, if you are mostly healthy, moderately wealthy and historically thrifty.
Having already passed through this celebratory gate, and while recently being guided like a Coney Island frankfurter into an MRI tunnel, two promptings occurred to me: I live in an incredible country that developed and advanced the technology where in just 18 minutes my orthopedist will know just how to correct a knee that has withstood pavement pounding a bit too long; and I have insurance that will cover all but the $250 co-pay for the examination. Technology to detect and correct, combined with resources to deflect the financial pain, made the brief hum of the jackhammer sound very bearable.
The health care crisis in America will be our single greatest challenge for decades to come and will probably determine the outcome of future elections at the federal and state level more than any other issue. Just the choice of a Medicare prescription plan for my parents and parents-in-law required advanced degrees in medicine, law and economics — none of which I have.
Top of the Charts
Transfer this gathering storm, for a moment, to our jails and prisons where already, according to the Centers for Disease Control and Prevention, more than $7 billion is spent annually on health care. Regardless of the size of the incarceration budget, health care has now become the second largest percentage of total cost behind personnel. Health care costs in wealthy California’s prison system now exceed 20 percent of the $5.6 billion annual corrections budget, and in less wealthy Alabama the cost of health care nearly doubled in the last five years, from $46 million to $75 million.
Although states feel the fiscal strain over a prolonged time frame due to longer sentences, the graying of the baby boomers, mandatory terms and older adults being convicted of sex offenses, counties also are experiencing the rarified atmosphere of stratospheric health care costs. A recent survey of per-diem costs in four of the jurisdictions surrounding Washington, D.C., found that all now exceed $100 per day, and the largest single increase in the budget was the cost of providing adequate health care.
A disproportionate contributor to the rising cost of prison health care is the rapid increase in the incarcerated population over age 60. In New Jersey, the number of prisoners older than 60 increased by 23 percent since 1999, while the total prison population declined by 14 percent. Nationwide, within the prisoner population, the cost of housing an inmate older than 60 averages $70,000 annually compared with approximately $23,000 for prisoners overall.
I have used the age 60 as the threshold year only because the first-born boomers are just now beginning to cross this maturity line. Within the incarcerated population, the age 50 would be a better indicator of aging due to many poor lifestyle choices of a misspent youth. Lowering the definition of elderly only exacerbates the health care crisis.
Incurable at Any Price?
Twenty years ago, most of us were convinced that HIV/AIDS would paralyze our correctional systems and render our facilities quarantined islands. Amazingly, we survived the fright, but at an enormous cost that will likely never be reversed. Always on our health care horizon, another potentially catastrophic crisis seems to loom and this time the danger is hepatitis C. According to Hepatitis C Awareness News, 20 to 40 percent of the incarcerated population has the virus. Avian flu receives more ink and airtime from the media, but hepatitis C is the creeping budget-buster in the early days of the 21st century.
Just as we have started to accept that gasoline will remain above two dollars per gallon forever, maybe we will also accept that the cost of health care is as elastic as National Basketball Association salaries. If we were so motivated, we could moderate superstars by not watching the games or buying the sponsors’ wares. Mandating budget cuts cannot control prison health care costs. We will ultimately pay the piper.
Fortunately, this topic is receiving a great deal of thoughtful discussion in every state legislature and county commission chamber. Some of the solutions will require a “no-holds-barred” evaluation of whether keeping prisoners like 99-year-old Ivory “One Round” Johnson incarcerated in New Jersey assures a safer society, even though he is a convicted murderer. We are one of few nations that hands out life sentences like chewing gum at a middle school dance. This is not intended to minimize the lifetime sentence that victims’ families receive, but to recognize that mandatory sentences are at least a factor in the rising cost of health care.
As the nation that perfected magnetic resonance imagining, we will explore a range of solutions, from sentencing policies to balanced diets; preventive medicine to Medicaid reimbursements; outsourcing services to tele-medicine. Technology will illuminate new pathways, but as with every one of us, the choices we have already made will probably determine the cost of aging.
While not “the greatest generation,” the boomers brought us music that you could dance to, cities that are livable again, 24-hour news coverage, and arthroscopic surgery to prolong the quest for youth. All we need now is to apply the same energy, imagination and influence to the management of the cost of aging both in and out of prison.
Stephen A. Carter, AICP, is principal of Carter Goble Lee LLC in Columbia, S.C.