Health care for the old and the more immediate costs of prisons

The explosion in the prison population in Colorado and other states has had extraordinary costs, both in terms of costing the state money and taking a human toll on the incarcerated. One of the largest costs of prisons is providing health care for the inmates. Inmates do have a right to health care under the 8th amendment, though access is in the best cases comparable to that provided for the poorest Americans, and at worst basically nonexistent. The problem is all this stuff still costs money.

One increasing problem is the massive recent rise in the elderly prison population. With sentences becoming longer and longer, violent offenders are now in prison so long they require costly medical treatments like dialysis or chemotherapy. Additionally, incarcerating the elderly is giving the taxpayers very little in the way of return on investment since older inmates are much less likely to recommit after release than their younger counterparts. With this in mind, it’s natural for some to see releasing the old or the sick from prison as a fairly simple way to save money:

“Any state facing an overcrowding situation or budget crunch has to think about releasing, and it makes sense to release older inmates who pose less of a risk of re-offending, as long as attention is paid to the crime they committed,” said Rachel E. Barkow, a professor at the New York University School of Law.

The opposition to this is naturally that this is dumb reason to let someone out of prison, and could also weaken the deterrent power of incarceration:

“That sends the wrong message to younger offenders,” said Michael Rushford, president of the Criminal Justice Legal Foundation, a pro-law-enforcement group in California. He and others who oppose early release of prisoners also say that lengthy incarceration has been one factor in the decrease in crime rates to historically low levels.

The nut of this issue here I believe is how to balance sequestration and fairness. The deterrent power of prison sentences or other consequences far down the road is pretty questionable, both intuitively and empirically. Most people who commit crimes aren’t doing a rational cost-benefit analysis of the consequences of their actions. Most of the power of long sentences to prevent additional crime and recidivism has to do with sequestration, meaning the prisoner is simply there long enough that he’s sort of cooled down with age. Basically we can decrease the crime rate by putting people in prison when they are most likely to commit crimes against the general public and making them commit crimes against each other.

That said, the upshot of this fact is pretty depressing. We could decrease the crime rate a lot simply by throwing everybody who is between 19 and 39 in prison, but that would be ridiculous. However, isn’t that sort of the natural consequence of releasing the old and sick from prison? If the real concern is recommitting, the best and most cost-effective types of sentences might be simply ones that hold inmates until a particular age. So I’d contend that the real issue with a policy like this isn’t the message it sends or anything to do with the deterrent rationale. It’s a fundamental question of how we balance the cost-benefit analysis of incarceration against the fairness of releasing people early simply because they were older when they did bad things.