Prison Health Care-Does Anyone Really Think This’ll Work?
Delaware’s Department of Correction is under Federal court order to fix a broken prison health care system. The alleged wonders of privatization have once again been exposed for what they are–private profit at taxpayers’ (and consumers’) expense.
The proposed solution? Break down the large failed bureaucracy into ten smaller bureaucracies, according to today’s News-Journal:
Rather than having a single health care provider, prison officials are breaking the contract into 10 smaller agreements focusing on specific services. The change comes a month after Corrections Commissioner Carl C. Danberg announced he was ending a contract next year with St. Louis-based Correction Medical Services (CMS), which has been criticized for providing inadequate health care despite being paid more than $130 million over three years.
Allow us to journey once again into the language of the bureaucrat, this time, DOC Commissioner Carl Danberg:
“We expect this flexibility, and the increased competition it is expected to provide, will foster improved medical care and cost savings,” Danberg said. “The Department spent significant time exploring alternative solutions to the way we contract for medical services. We believe this alternative will allow for large and small service providers to bid on the areas that fall within their specialization.”
So far so good. As we delve deeper into the article, however, it appears that such expectations bolded above are more dependent on faith than on actual, you know, data:
Danberg has said he is not sure if the new contract format would reduce costs, adding that results he’s seen across the country are mixed. While more companies competing for more bids would likely be financially better for the state in the short run, managing a larger number of vendors could become a problem as it increases other costs, such as hiring more people to oversee vendors.
Bottom line: This is what we know and what we do not know. Either this will reduce costs or it won’t. Either this will provide improved medical care or it won’t. That much seems clear.
Believe me, I’m not here to diss Carl Danberg. He seems to be Delaware’s best ‘go-to’ guy when it comes to, as Donald Regan put it, “cleaning up after the elephants.”
He inherited this mess, and he’s doing the best he can.
However, I’d like to ask just a few questions that might clarify whether this proposed cure is better than the disease it seeks to remedy.
1. How can 10 mini-bureaucracies be more efficient than one large bureaucracy? Has this model empirically worked anywhere, especially when it comes to health care delivery?
2. An effective and efficient health care delivery system would seem to depend on superior coordination amongst its many branches. How is this even possible with 10 different contractors working their own individual mini-bureaucracies? Who will be the ‘grown-up’ in this equation?
3. Doesn’t a splintered system like this, by its very nature, lend itself to ‘passing the buck’? As in, that’s not our responsibility that’s fill-in-the-blank’s responsibility. Multiply by 10, and you get what I’m gettin’ at.
4. Why in hell should Corrections Medical Services (CMS) be allowed to bid on any element of this contract? Their misfeasance and malfeasance is the principal reason that the State is under court order to clean up this mess.
None of these questions were answered in the article. While I fully recognize that the State is under extraordinary pressure to do something, absent any empirical support that this plan might work, why is it even being considered?
A couple of final points. Yes, prison health care would be much better if the prison population was reduced, as was suggested by an expert quoted in the article. And I think that the judiciary has finally challenged the notion of mandatory sentences for non-violent offenders to the point where reform is in the offing. However, profit-driven enterprises providing contractual services previously done by state employees will invariably seek to maximize profits by providing as little care as they can get away with. Just like CMS did.
Which is why I’d like to see the state do a cost-benefits analysis to see whether it makes sense to restore these responsibilities to state employees and do away with these private contractors. States all over this country were sold a bill of goods on the wonders of privatization. Hindsight being 20-20, it’s no surprise that the privatization advocates snowing the General Assembly turned out to be the blind leading the blind.
They may actually have to hire a vendor to manage all of the vendors.
I wish I was joking.
RFP at 11 🙂
The Dems can’t deliver effective healthcare to a confined population, but you think they will do better when they are in charge of the whole healthcare system…
absolute insanity
Well, liz, we could let Aunt Bea do it. But don’t let Deputy Fife run any errands.
In fairness to Carl Danberg, the logic likely goes something like this: There aren’t many companies nationwide equipped to do the Whole Enchilada of prison health care. If the company you contract with turns out to be an Epic Fail, as with CMS, you’re screwed. How can you simultaneously extricate yourself from a problem vendor at that level while continuing to provide services?
The corollary to that theory is that, at the less gargantuan level, there are many vendors equipped to provide a more narrow range of services. So, if one has to be swapped out due to performance issues, it is actually a manageable process.
I still don’t get how someone can be a successful cat-herder of so many contractors. And I still don’t see how this will work in practice. But, at least there appears to be some logic behind the move.
Private health insurance companies can’t deliver effective healthcare to anyone, and Medicare remains extremely popular. So yes, I think a move away from privatization will be more effective no matter who is in charge. That should be the solution Danberg pursues, rather than give out 10 more contracts to corporate buccaneers.
Didn’t Danberg work for the DOC for 8 or 9 years before he took it over? From the mid 90’s until 2005, then he took it over in 2007. He’s been running it for almost 3 years now and its still a mess.
To be totally honest, from what I’m hearing I don’t think delawareans give a dam if murderers, rapists, or sex offenders have healthcare at all. It’s hard to have sympathy when alot of Delawareans are being laid off, or have no benefits themselves. If the R’s (Sir Copeland and CRI) think this will become a campaign issue, they are wrong.
DOC’s been a mess from time immemorial. According to Wikipedia, granted not always the most reliable source, these were Danberg’s duties:
“He was responsible for community, legislative and media relations, managing victim services, budget preparation and drafting legislation as well as training and advising correction staff.”
He was never in charge. He did an excellent job as AG when M. Jane Brady decided that she wanted to be a judge.
Laying the mess of DOC at his feet is unfair.
He is now, however, on the clock when it comes to cleaning up the mess.
No one in their right mind would trade their medicare coverage for private insurance. That should answer the lizards question.