Human rights Opinion

Medicare must be accessible for prisoners

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Children in prisons do not get adequate access to health care (image via Adobe Stock)

I see prisons where hearts are broken; life’s brief light extinguished.

It is my experience, in general, people come out of prisons in worse conditions than when they commenced the situational trauma of incarceration.

Be patient with things of this world, it is all too often said. The wait makes the affected old before their time. We incarcerate like never before, demanding quiet in the darkness. 

Health inequalities and discrimination in this nation’s 132 prisons are rife. Nearly 45,000 prisoners are denied Medicare. Therefore, Medicare is not universal as is touted. 

Medicare is denied to prisoners, old and young, and to children as young as ten. Oftentimes filled with tears, unseen weeping, unmasked sorrow withheld within till the perishing.

In addition, the incarcerated in effect are denied access to the Pharmaceuticals Benefits Scheme and denied access to the National Disability Insurance Scheme, with disastrous impacts.

It is established and self-evident, nearly all of Australia’s prisoners are comprised of people living in the lowest quintile of income. Additionally, they also comprise the quintile of the weakest primary and secondary health.

The Australian Labor Party argues Medicare is universal and at times has included in their national policy platforms a promise to end the health discrimination of the incarcerated. They are yet to do so.

The situational trauma of incarceration should never accentuate and accumulate further trauma. Health equality advocates argue prisoners should in the least be availed to the same level of healthcare as everyone else. 

My daughter Connie coordinated a campaign in recent years to ensure access to Medicare to the incarcerated. They also come in with a high rate of unaddressed ailments and poor health and prisons should be at the least transformational. There should be an onus on “catchup” health, addressing physical ailments, improving their overall health and addressing psychosocial issues and their psychological wellbeing. They will be less likely to reoffend.

I recount prisoners who complained for months and years of pain because those who were meant to heed did not. They were not referred but given "paracetamol". Their cancers spread.

Medicare is a health funding stream to be accessed by every Australian, to ensure rapid access to vital services.

For a decade, the Australian Medical Association (AMA) has advocated for prisoners to retain their Medicare rights.

The AMA states: 

'The loss of Medicare and of PBS entitlements while in prison exacerbates the cycle of ill-health experienced by prisoners and detainees.'

Furthermore, the AMA also insists the quality of healthcare has an indisputable impact on the rehabilitation of the individual:

“Poor healthcare in prisons results in poorer physical and mental health long-term.”

State and territory governments were made responsible for the provision of healthcare in prisons. 

The Commonwealth Health Insurance Act (1973) includes a clause to prevent "double-dipping" of medical services. It assumed states and territories would fund equivalent access to health services and build internal health systems in prisons. They do not.

The Federal Government has an opportunity to strive for its "leave no-one behind" claim.

More than half a million Australians – one in 50 – have been to prison. Poor health marginalises people into unemployment and underemployment.

The ALP argues 'all Australians have a right to the best possible health'.

There is no worse discrimination than health inequality. Many readers will find it hard to believe health rights such as Medicare and PBS are denied to Australia’s 44,000 incarcerated adults and to nearly 1,000 incarcerated children. There has been a long silence about this life-threatening inequality. When will we speak of this cruel unfairness and call for a love of one another?

I am reminded of Desmond Morris' book, The Human Zoo, of his description of the harassed city-dwellers in teeming concrete jungles, debilitated. In fact, the grossest concrete jungles are the prisons where in my view the affected are maltreated as once were "lepers", held captive to demonisations and ceaseless cruel harassment. There is nothing redemptorist about prisons.

Some of our restorative work in adult and children’s prisons allowed us to witness the effects of health inequalities, the impacts of no Medicare. There is seemingly endless horror stories of untreated infections that led to amputations, and worse, death.

With the criminal age of responsibility still at 10 years old, jailed primary school-aged children are denied Medicare.

Every prison should have a general practice physician on-site, with whom Medicare can bulk bill. Prisoners have a higher prevalence rate of co-morbidities than the general population, higher rates of disabilities, high rates of acute mental health conditions, and First Nations prisoners have even higher rates. One in six First Nations people living have experienced incarceration.

Prisoners are nearly three times as likely to have acute mental health conditions compared to the rest of Australians and up to 15 times as likely to have a psychotic disorder. First Nations prisoners once again are hostage to higher rates.

With First Nations individuals making up nearly 30 per cent of the national prisoner population, as well as having a higher susceptibility to health issues, healthcare "catchups" in prison are a missed opportunity. 

Half a century has passed and Medicare (Medibank in its first iteration) has in fact not been universal throughout Australia. All it will take is moral political will. The federal Health Minister has the power to immediately provide Medicare to prisoners. Simple legal amendments can guarantee universality.

Gerry Georgatos is a suicide prevention and poverty researcher with an experiential focus on social justice. You can follow Gerry on Twitter @GerryGeorgatos.

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