CESAL: Wondering About ‘Medicare-For-All’? Here’s How It Works In Prison

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Craig Cesal Contributor
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“I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.” – Matthew 25:36

You might think a federal prisoner, especially a marijuana conspirator sentenced to life imprisonment without the possibility of parole, is cut off from the world. Quite the opposite is true. The world at large is actually cut off from the prisoner, although in many instances, the world is prudently shielded from the prisoner. Federal prison is the epitome of the U.S. government’s hegemony over its citizens and residents.

The feds decide what medical care I receive and when I receive it. They control the food I eat, clothes I wear, when I sleep and wake, and even what news I receive. Our communications, both incoming and outgoing, are censored. We are disciplined severely if we try to communicate to someone outside the fence that we have been beaten by a guard. North Korea and Cuba have nothing on us.

We can soak up radio and TV news that is broadcast free of charge, and thus tightly regulated by the government. Lately, we have heard a lot of talk about “Medicare-for-all,” which we prisoners know more about than anybody. Clearly, the ideology driving socialized medical care is that socializing it will make it fair. That is, no one will be jealous of what another person can buy. Everyone will get the same care. We, the 900 prisoners held in the medium custody prison at Terre Haute, Indiana, go to the same medical facility, stand in the same lines, and are treated by the same people. It is fair, I suppose, in that we are not envious of others buying better medical care or faster care, but it is neither utopia or even good care. (RELATED: I Never Smoked Marijuana — But I’m Serving Life In Prison Over A Marijuana Charge)

As a business major in college, and as a business owner for many years until my arrest, I was amazed at how well equipped the FCI Terre Haute Medical Services Department is. There’s the x-ray equipment, complete optometry stations, four complete dental stations with big, fancy x-ray machines, and even the most fancy defibrillator machinery. But to me, from years of watching the bottom line at a business, the medical staffing levels were the most astonishing sight. The full-time medical staff consists of two doctors, two physician assistants, six RN nurses, one EMT, an x-ray technician, one dentist, two dental hygienists, one dental assistant, five clerks, and two administrators. This doesn’t count the part-time contract staff including the optometrist, physical therapist, two pharmacists, heart surgeon, orthopedic surgeon, MRI and ultrasound technicians, and even more. I harken back to business school: a city of 900 people could never afford this. 

I sit back, scratch my chin, and ponder why they employ so many medical professionals — all highly paid with huge retirement benefits. Then the epiphany struck: it’s the bread factory in the Soviet Union! In that socialist system, the bakers at the bread factory were required to go to work every day, and if they did so, they got their government ration book. They did not have an annual performance review where they could get a raise if they were making lots of tasty bread. Their jobs required them to go to the factory, nothing more. 

With no incentive to make a lot of bread — they spied the few who did little or no work and received the same ration book, and reckoned, “Why should I bust my…?” This became the rally call. Well, before long, they didn’t make much bread at the bread factory. Townspeople stood in line for days to scarf up their ration of the meager amount of loaves that were produced. The prison medical department is the USSR bread factory.

Here’s how the socialized medical treatment works. Suppose a medical condition arises. For example, an inmate feels lethargic, and he notices blood in his stool. He figures he likely needs some sort of treatment. The first step is called “sick call,” where we request medical care. Four days per week, inmates line up at 7:10 AM, with the prescribed form filled out identifying the complaint, and notifying us of the $2 fee.

Over the next hour or so, each inmate is called into an examination room to be triaged by a nurse. The nurse makes a cursory evaluation to determine if there is a medical emergency, meaning the inmate would perish before the day is out. If not, he is told to watch the “call out,” which is a list of appointments for each day. The bleeding inmate would be put on the list to be further triaged by the PA in the next two to four weeks. 

The PA does a more comprehensive evaluation and determines that since the blood is coming from within the inmate, he needs to be further evaluated by a specialist, rather than more evaluation by the prison doctor. A request for approval for an outside doctor to evaluate the inmate is written up and sent to the Utilization Committee. 

Typically within the next two to six weeks, the committee approves or denies the request, and the choice seems to be based on a coin toss. If denied, the inmate is told to go to sick call if the condition persists. If approved, the medical clerk schedules an appointment with the cheapest doctor, usually within the next six months. (RELATED: I’m Jealous Of Inmates On Death Row — Here’s Why)

After a blood test and some poking and prodding from the specialist, it is determined the inmate suffers from Crohn’s disease. The specialist prescribes Humira, taken once per day. The medicine would likely render his Crohn’s into virtual remission. Back at the prison, the inmate lines up every day to pick up his new medication but none arrives. He is told to go to sick call again.

Three weeks later, the PA advises Humira is not on the federal government drug formulary, a list of drug the Bureau of Prisons can provide inmates. Humira is likely considered too expensive to put on the list. The PA prescribes the formulary medicine for Crohn’s and tells him if it doesn’t work, he should return to sick call. Of course, the specialist didn’t prescribe it because it doesn’t work.

At least the Soviet bread factory made bread. To make it worse, American civil service employees are virtually impossible to fire from their jobs, if anyone cared enough to do so. Even with two full-time doctors and PAs working every day, fewer than 20 inmates are scheduled for examination each day. Most of them are scheduled every six months, like me, to get insulin or other prescriptions renewed. This is an average of five office visits per physician per day. If a private doctor in the city of Terre Haute saw only five patients per day, they couldn’t afford to keep the lights on. 

Since I’ve been in prison for nearly eighteen years, I have no idea how to use an iPhone, and I’ve never seen a tweet. I know very well what socialized medical care is, as championed by all the candidates at the Democratic debates. Even folks who rely on Veterans Administration care have the option of hiring their own doctor or paying for their own Humira. Even active duty military can see private doctors. Those of us enjoying socialized medicine don’t have the option of paying those bills, or seeing those doctors, but too often, we would love to do so. However, that might not be “fair.” It may make someone green with envy.

Here at the prison, it takes us more than two years to get an annual dental check-up or cleaning, usually more than three years to get a filling, two years to get eyeglasses, and five years for dentures. But it’s “fair.” Everyone experiences the same service, even though it’s bad service. Everyone in Russia got the same amount of bread — not much. As Marx or Lenin might have said, “Be careful what you ask for; you just might get it.”

Craig Cesal is serving a sentence of life without the possibility of parole in Indiana’s Terre Haute prison for a “marijuana” offense. He co-owned a towing company that recovered and repaired trucks for a rental company, some of which were used by smugglers to transport marijuana. He graduated from Montini High School in Lombard, Illinois in 1977. His daughter, Lauren, has obtained more than 300,000 signatures on a petition calling for clemency.

The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.