This one’s an attempt to organize and structure some scattered thoughts I’ve had over the last year or so on this subject:
How do I feel about using my talents and training promoting the health, wellbeing, and longevity of a population of patients that society has deemed worthy of revoking most of the other privileges of a free society. Prisoners.
Of course, the cynical/most true answer here is, “I was unemployed and CCHCS were the first people to offer me a job1.”
But let’s pretend for a little bit that I’m less flexible and that this might, for me, be a thing that is an actual, significant moral question—especially considering the opportunity costs right? I could be serving people who “deserve” it more along just about every possible metric we can think of.
The answer that mostly satisfies me, despite kind of kicking the can on the problem down the road a bit, is something like this: “society has decided the health of its prison population is something it cares about sufficiently enough that I am a conduit of its willingness to invest in it”. For one, this is true almost literally, being that I’m contracted with the state of California. We can go further on this by exploring how we got here.
Prison healthcare isn’t great, but it’s far from the nightmare certain activists will love to pretend it is. This is thanks to a combination of two things: ample law suits and the Eighth amendment. There’s a really useful resource that explains a lot of this background available from the Pennsylvania Institutional Law Project’s Prisoners’ Rights Handbook (available from PILP’s self-advocacy materials but I originally found and am going by a different edition available here). They explain:
In Estelle v. Gamble, 429 U.S. 97 (1976) the Supreme Court first considered a prisoner’s claim that the inadequacy of medical care constituted cruel and unusual punishment under the Eighth Amendment. Gamble, a Texas prisoner, brought suit alleging that he received inadequate medical care following a back injury sustained while working. 429 U.S. at 98. Justice Marshall, writing for the majority, held that deliberate indifference to serous medical needs of prisoners constitutes the unnecessary and wanton infliction of pain proscribed by the Eighth Amendment. 429 U.S. at 104. Justice Marshall reasoned that since incarceration denies prisoners the ability to care for themselves, the government has an obligation to provide medical care for them.2
Now, there’s certainly more history before and after that but the point here is that this is something people have thought about and found justification for.
But, do I agree?
Well, it’s hard to disagree with the most basic premise; “should everyone have access to quality healthcare” is a question with an easy yes. Problem is, healthcare provisioning is a limited resource. There’s only so much medication, only so many doctors, only so much time in a day. And so we need to decide where put our supply and demand curves.
From that perspective, “who deserves healthcare” is an important question3. As mentioned before, I’ve heretofore sort of not spent much time thinking about this too much. Gun to my head: no, I think every cent spent on healthcare here should probably be going somewhere else.
I guess the next question in my personal context is, how does the prison healthcare system locally compare to, at least, Medicaid locally? I would very much prefer that the average California citizen have better healthcare than the average California prisoner. Medi-Cal is not great but I’d still probably describe it as “better than Medicare”. Wait times are pretty bad but treatment options are pretty robust and drug coverage (for what’s covered, which is surprisingly a lot) is complete.
I would need closer firsthand experience with how scheduling and access to healthcare is from prisoners’ point of view to judge. There’s a lot about it I don’t know, for one I’m not sure if they’re being charged for their healthcare at all. From the pharmacy things seem to compare pretty closely; if anything, questions of access come down to CCHCS competing very poorly for quality healthcare workers4.
My raw judgment is that for better or worse, Medi-Cal is pretty comparable to CCHCS.
Do I feel like my time is being wasted here? Yes, but for purely compensation-related reasons5 that will probably someday deserve their own post to complain about. Morally? I don’t know; as is I’m happy to kind of keep kicking that can down the road.
Well, contract job, and CCHCS did absolutely none of the work to make it happen. Wait hold on I can’t recall if I’ve done this rant proper yet. I’m being given the run-around on over a dozen permanent positions with CCHCS throughout the state with some of the highlights including being scheduled interviews with no notice on positions I applied for 4+ months ago and being rejected for a position at the institution I’m currently working at despite being the only person who bothered to show up for the interview…and yet the way I got my current contract position was I applied to a posting by a staffing agency on Indeed and was hired after only two days and a barebones interview that I was handed the script to. My management company had even been misled on the nature of the contract; they’d been told it was part-time floating between multiple institutions when it turned out to be full-time at a single one—and they got lucky that I was okay with all of this.
This might deserve it’s own full post in a few months.
This may or may not be unique to California but engaging petty law suits is now sort of an underdiscussed part of modern prison culture. As much as some of broader culture likes to indulge in the criminal stereotype being severely uneducated, these guys are often clever in a lot of unconventional ways, including legally. As one of my colleagues is fond of saying, these guys have basically unlimited time and resources to nurse legal grudges. Some of the correctional officer training around the body-worn cameras that are now required is that inmates will absolutely know about and bait them into administrative policy violations.
And, inevitably, a political question, so we have to decide which coalition signaling choices we’re going to make.
Aside from generally having trouble finding people who are willing to deal with (potentially violent) inmates, they have difficulty attracting quality healthcare workers at all. The average quality of nurses, doctors, and, frankly, pharmacists are pretty low compared to what I’ve seen elsewhere. Some of this is CA state jobs being ridiculous to even apply for as indicated in the first footnote, what I left out is that you have to apply to be placed on an eligibility list to be able to apply to the jobs, then you have to wait an arbitrary number of weeks to be scheduled for an interview with little warning and no input for you with no option reschedule (the most egregious personal example was that I was scheduled for an interview for a position I’d applied to 6 months prior, in the middle of the day, 10 days after I received the interview notice), and if you hear back at all after it’s another 4-8+ weeks. They’re having to offer teleworking to attract any physicians, psychiatrists, or psychologists at all.
I’m making roughly the same I made at chain retail but with no benefits and no indication that my time here has given me any advantage in applying for actual positions with CCHCS. I’m told the actual staff pharmacists here are making about 30% more than I am as well, which is very unsettling.