Illinois votes to eliminate inmates' doctor visit co-pays, equivalent to one month's wages

Illinois lawmakers have want to end inmates' co-payments of $5 for each prison doctor visit — the equivalent of a month's wages in the prison's $0.05/hour and under workshops; in Oregon, they're contemplating creating a $3-5/visit co-pay.

There are 42 states where prisoners pay to see doctors, with the national average at $3.47/visit: for example, Washington State ($4/visit), Oklahoma ($5/visit — equivalent of a $580 co-pay for a minimum-wage worker) and Nevada ($8/visit, highest in the nation). Texas prisoners are billed $100/year (set to double as Texas prisons struggle to stay funded after Republican tax-cuts).

In addition to the cruelty of depriving someone of their liberty and then denying them live-saving medical care, limiting prisoner health-care is financially imprudent, creating the conditions for pandemics that endanger whole prisoner populations, as well as nearby communities. Meanwhile, the co-payments are so small in real-world terms that they do almost nothing to defray prisons' medical costs.

The problem of co-pays in prison is a kind of microcosm of the overall problem of disincentive payments and levies under inequality. The rationale for co-pays is that it reduces frivolous doctor visits by creating a small disincentive that makes people think twice before seeking care. But under conditions of extreme inequality, the one-percenter never even notices the speedbump thanks to the million-dollar suspension that guarantees them a smooth ride; while a poor person faces a thousand-foot-high wall rather than a speedbump, because they don't have wealth to ride on, but rather a ton of debt that they have to push ahead of themselves.

There were a lot of progressives that cheered London's congestion-charge, but for all the good the charge did in reducing emissions in the capital, it's also incredibly discriminatory. People who live inside the c-charge (who are far more likely to be millionaires than people in any other place in the UK) don't pay one penny; bankers who commute in from country estates don't even notice ten or fifteen pounds a day; but struggling builders and tradespeople with white vans who have to drive a vehicle in London to earn their living face a steep erosion of their already barely adequate take-home pay.

The same is true of the argument for charging more for on-street parking: it's important to get our cities off of individual vehicles and into public transit, and parking charges can help fund that, but if you're a cleaner earning $10/hour and you have to pay to park as you shuttle from job to job every day, you're paying a regressively high share of the cost of transitioning to public transit, while the well-off people whose toilets you're scrubbing don't even notice the high cost of parking.

It's a problem that can't be solved within its own parameters. Having gutted progressive income tax and inheritance taxes, creating mass inequality and starving the treasury, we run out of money for transit, health care and environmental remediation. This makes user-fees and "disincentives" seem like a good idea — because it's politically impossible to rebalance inequality through taxation — which bite hardest at the people who can afford it least, and make inequality even worse.

Prisons charge co-pays for similar reasons as free-world health insurers: to cut down on unnecessary medical visits by requiring patients to share in the cost of their care. U.S. prisons spend between $3,000 and $10,000 per inmate per year on medical care—about 20 percent of total prison spending—according to a 2014 analysis by the Pew Charitable Trusts.

"We want a real-world environment for the prisoners because in the real world you and I would be required to have a copay," Mark Myers, spokesman for the Oklahoma Department of Corrections, told the news site the Frontier. Prisoners in Oklahoma earn 5 cents per hour at the bottom of the wage scale, so the state's $4 co-pay is roughly equivalent to $580 for a minimum wage worker on the outside, the Frontier reported.

The $580 Co-pay [Beth Schwartzapfel/The Marshall Project]

(via Naked Capitalism)