Reviews | Why are prisoners paid a pittance to make glasses that I prescribe to poor children?

Julius Oatts is a pediatric ophthalmologist and assistant professor at the University of California, San Francisco.

Around the start of the pandemic, I operated on the eyes of a child born with cataracts. To prevent irreversible blindness, it is necessary for children to start wearing glasses immediately after surgery. For this child, I was told the glasses would take at least six weeks to arrive – a serious and vision-threatening delay.

The reason for the delay? Coronavirus-related closures of an optical store in a nearby prison staffed by incarcerated people, who in California are typically paid between 8 cents and 37 cents an hour. I struggled with conflicting feelings: alarmed at the delay in getting glasses for my patient and concern for the welfare of the people making them – due to substandard prison health care and shockingly low wages.

This child, like many of my patients, was insured by Medi-Cal, California’s Medicaid health insurance program serving low-income children, families, and seniors, typically those earning less than 138 percent of federal poverty level (currently $38,295 annual income for a family of four). In the current fiscal year, the California Department of Health Care Services, which oversees Medi-Cal, agreed to pay up to $37.9 million for optical services for adults and children operated by the California Prison Industry Authority, a semi-autonomous prison labor agency under the California Department of Corrections and Rehabilitation. The arrangement dates from the 1980s.

The California penal code requires the state to purchase products, such as eyeglasses, made by imprisoned persons under the supervision of the prison industry authority. Colleagues and I recently published an article in the American Journal of Public Health examining the relationship between taxpayer-funded health care and prison labor in California. We discovered through a request for public and confirmed records from the California Prison Industry Authority that state Medicaid contracts accounted for up to 74% of the authority’s approximately $13 million annual revenue from optical services.

So taxpayers and a public health care program for poor children help subsidize an agency that oversees prison labor. The practice is not unique to California; other states that use it include New York and Pennsylvania.

Prison work is often unpaid or low paid. The 13th Amendment allows the government to force incarcerated people to work without compensation – something many critics today see as a modern extension of slavery. I am among them.

I agree that prison work, especially eyeglass making, teaches job skills that can theoretically help with reintegration after release from prison. What I object to is the tiny compensation paid to jailed workers – usually a political concession to companies and unions concerned about competition.

In recent years, Colorado, Nebraska and Utah have banned “involuntary servitude,” paving the way for better wages and working conditions in prisons. Paying prison workers minimum wage appears to be the least palatable policy, but a June effort by California lawmakers on that front failed amid concerns over the estimated $1.6 billion cost. That’s no small amount, but it represents less than 1% of California’s $110.4 billion budget for 2022-23.

The state Senate tried last spring to target the prison-made eyeglass arrangement, unhappy with reports of long waits by Medi-Cal recipients for the glasses. (The state has attributed delays, like the one I experienced, to pandemic-related illnesses and lockdowns, but an industry association says delays persist.) A bill proposed to allow Medi-Cal to pay for glasses obtained from private optical labs, but the bill was derailed in committee. Either way, some lawmakers were willing to bless paying what a state analysis found would be a 141% premium to private-sector sources above the rate for prison-made glasses.

Earlier this year, California “employed” 295 people incarcerated in optical programs at three prisons, with that number expected to rise to 420 over the summer as another operation was fully open. Paying them fairly – and even increasing their number to meet demand or speed up delivery times, if necessary – seems eminently preferable to paying a premium to private laboratories.

If incarcerated people were paid minimum wage to produce eyeglasses, I would still feel conflicted, but I would be relieved to feel that simply by prescribing vision-protective eyewear to my state-insured patients, I am unwittingly participating in system operation.

As for this infant who had cataract surgery and whose urgently needed glasses were delayed, I was finally able to get them faster thanks to a philanthropic organization that allows families to bypass optical labs by prison contracted by Medi-Cal. Such workarounds can help children avoid preventable vision loss, fortunately, but they are not a long-term solution. Ultimately, the fundamental inequalities of the current arrangement will have to be corrected.

In medical school, I took an oath to “do no harm”. I have since had the opportunity to reflect on what ailment means and when it can occur far from the doors of the doctor’s office.

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