THE METASTATIC GROWTH OF AN AMERICAN SOCIALIZED MEDICINE SYSTEM

Barry L. Stanton appears at ease in his spacious new office as he discusses key issues at the Prince George's County Correctional Center in Upper Marlboro. But Mr. Stanton, director of the county Department of Corrections for the past nine years, tenses as he bemoans the jail's rising medical costs for inmates. "People get better medical care in jail than I get at home," he says from behind his desk in the jail's new $8 million annex. "If you pick up the phone and you say, 'I am sick' ... they say, 'If it is not an emergency, I will see you tomorrow,'" he says. "Here, [inmates] want to be on sick call right way."

He has seen the Prince George's detention center's average cost per inmate rise from about $83 per day in 2003 to nearly $100 per day last year, while more and more inmates crowd the jail's spaces. Mr. Stanton is not alone in his concerns. Most detention centers in the metro area are dealing with increasing medical costs -- which are covered by taxpayer funds -- and overcrowding, reflecting a national trend.

At the D.C. Jail, inmates routinely are double-bunked in cells designed for one person in most of the 30-year-old facility's housing units. The jail -- one of the oldest detention centers in the region -- can adequately house 2,164 inmates a month, according to a consultant's recommendation in 2004. However, the jail usually houses more than 2,500 inmates a month and sometimes holds as many as 3,555 a month, according to D.C. corrections officials. Most inmates are pretrial defendants awaiting hearings, and their numbers fluctuate as the courts handle their cases. Many inmates also are awaiting transfer to federal prisons, and the remainder are serving sentences.

According to statistics from the U.S. Justice Department and the American Correctional Association, the D.C. Jail's average cost per inmate rose from about $65 per day in 2003 to about $78 per day in 2004. D.C. officials estimate the cost rose to about $86 last year. "I would definitely agree that the cost has risen," says S. Redwood York Jr., who has served as the interim director of the D.C. Department of Corrections since February. "And it is probably a factor of having higher support costs in medical, food service and other inmate needs, combined with the increased population."

City officials attribute the rising costs in part to the jail's exhaustive health screenings, which include voluntary testing for AIDS and tuberculosis. City law requires that the screenings be provided to all inmates, regardless of whether they have been convicted or are being held for trial. Repeat offenders and suspects must be provided with repeat treatments by the jail's more than 140 medical staffers, who work alongside the facility's 687 guards. "We are hoping that someone will understand that we cannot go on doing what we are doing," says Dr. Malek Malekghasemi, the D.C. Jail's associate medical director. "You cannot tell people 'no' because ... inmates have a constitutional right to health care."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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