Private Prisons & Private Medicine

I was reflecting on these industries that reside south of the border that are constantly threatening to move north like a fleeing refugee, and wondered whether they aren’t built on the most oxymoronic of business models.
Let’s take private prisons first. The aim of society is to produce as few felons as possible, and where they sadly and inevitably manifest themselves, to incarcerate and rehabilitate them for life on the outside as quickly as possible. Therefore the KPI (key performance indicator) should be 0% prison population for a society to be judged as progressive and successful. Well, the private business model is based in growth in customers and consumption.

Therefore, in the prison case, we need more prisoners, and each year that population must grow to attract shareholders. The private model is based on increasing prices (costs to the taxpayer) to meet profit targets. And if demand declines due to increased progress of that society, then more criminals must be created in the interest of demand stimulation. I have often wondered whether private prisons are sponsors of street gangs, prostitution and drug trafficking – hell, you gotta feed that demand pipeline!

Now let’s take private medicine. The same healthy demand pipeline is necessary. What is more, we need repeat customers and long term customers to provide for some form of stability to the base. We must never totally cure a customer in case he doesn’t come back. He should be left in a chronic state of dependency on pharmaceutical drugs. And if a supplemental market can be created for secondary drugs that alleviate the side effects of the primary drug, all the better. I know one patient who is on six drugs to counteract one medical condition: one for the primary condition and five for the side effects and the side effects of the side effects of the first drug. Barriers to entry must be created with patents so that drugs can be exploited for maximum profitability. Integrated and alternative forms of preventative medicine should be shut out for they inhibit demand or create demand elsewhere. Product obsolescence must be built in so that drugs can be supplanted with stronger drugs. Viruses become stronger over time they say and therefore the drugs must increase in potency robbing patients of their natural immunity, reducing them to being ever more dependent on pharmaceuticals. I wonder whether private medical providers are secret sponsors of smoking – hell, you gotta feed that demand pipeline!

I’m sure the public versions of prisons and medicare have created their own bloated bureaucracies leading to the accusation that governments would be better suited sticking to passing legislation and getting out of operations. But the public funding tool can also be used to make these institutions better, by allocating to real needs and re-allocating from the bloat, and by holding administrators to measurable and actionable goals. The public version still comes ahead because it is based on zero profit and on the allocation of scarce resources towards the welfare of the community rather than on maximising profits for a small group of shareholders.

And then I reflect on our southern cousins and wonder why the majority of them still don’t get it? Is it because they have never had it before so they are scared of change? Have scheming politicians, minions of the private sector, scared them silly with the “failed” experiments in other countries that have led to long wait times for service, conveniently ignoring the fact that back at home, for some, there is no service at all when it comes to medicare? And in the case of private penal systems, that law enforcement forces rely on fines and penalties to keep their budgets balanced? That despite this privatization, they still have the highest per capita prison population and the highest cost of medicare?

This is a conundrum that I do not have an answer for. Perhaps the path to enlightenment lies in gradual evolution at the state level, until someone hits on a magic bullet that everyone latches on to and the revolution happens. Until then, we wait, and hope like hell that these two systems get stuck at the border and never creep north.

A South African Journey

I recently travelled to South Africa to research a novel. This was a journey taken 225 years earlier by a European ancestor of mine who sailed via the Cape of Good Hope for the East Indies. This ancestor never returned from the East—in those days journeys of that nature, lasting several months, were undertaken once in a lifetime, and usually performed one-way only. Today, one-way was a 16 hour non-stop flight from New York.

The first thing that struck me was that this was a developed country, if development could be measured in materially progressive signs like transportation, commerce and communications infrastructure. But on closer inspection, the country’s social fabric, a mere 20 years after the dismantling of Apartheid, is still mired in dysfunction. “Townships” remain on the outskirts of residential suburbs, and are run-down shanties in the most appalling conditions, while the “white suburbs” are opulent, sprawling and gated. Coloured communities straddle the middle ground. The new South Africa, post Mandela and de Klerk, is not going to copy its neighbour Zimbabwe and steal from the rich to give the poor, I was told; there has to be a willing buyer and a willing seller when it comes to land transfers. But with buyers without the means to buy and sellers unwilling to part with hereditary land, the impasse of inequality continues.

Political awareness is high among the locals, and no conversation ends without some reference to race. I was quite surprised when terms like “black,” “white” and “coloured” were thrown about so casually. Street protests and demonstrations were rife, be it breakaway factions of the monolithic ANC or students protesting the raising of tuition fees.

And yet, when you leave the messy people issues behind, the land is ruggedly beautiful and ever contrasting. From the stunningly scenic Cape Town and its cloudy sentinel Table Mountain, where everything began (at least for the white colonists), to the Cape Flats and its crumbling townships, to the fertile wine country in Paarl and Stellenbosch, to Hugenot country in Franschoek, to the dry Karoo with its scrub vegetation, acacia and agave, and then down and across the Eastern Cape with its giant pine and imported gum trees, the land is ridged with progressive mountain ranges, creating micro-climates within their valleys. Finally, one comes across the tallest range, the Drakensburg, that straddles two other environments: the grassy high veldt and the dry low veldt, the latter being home to the country’s famed Big Five and a myriad of lesser quadrupeds—a must-see for the avid tourist.

The complexity of South Africa came home to me in Johannesburg, the City of Gold, built on abandoned mine shafts, with splotches of gold from abandoned mines still adorning its landscape. The city’s history is littered with the carcasses of those who died from poor mine conditions, arsenic poisoning being the main killer; it’s labour history bears many travesties, among them: how mine owners reduced migrant worker wages by 50% in 1902 and kept them frozen for 60 years! The city’s core is virtually abandoned to hordes of immigrants (mostly illegal) who have forcibly occupied areas like Hillbrow, while new business districts like Sandton spring up on the periphery of this sprawling metropolis of 10 million. And yet enclaves like Houghton, covered in a blanket of purple jacaranda flowers, are islands of opulence and calm. I felt at home in Soweto, Jo-burg’s own township, a city unto itself of 3million where shanties jostled with modern haciendas replete with BMWs in their garages. Life was on display in Soweto, from street performers to open air restaurants, to “buy your own shanty” sales, to the bullet-riddled house of Nelson and Winnie Mandela that opponents used to drive by and take pot-shots at while Winnie and the children were still indoors. And there were some overlooked marks of embarrassment too: forgotten street signs of a bygone era, reading “Whites Only,” or “Coloureds Only”.

As I left South Africa with a book full of notes, I realized that Apartheid was still alive, even if only as a socio-economic reality, blighting this otherwise energetic, rich and beautiful country. I also realized that it would take many generations before that legacy is finally eradicated, if ever. It certainly will not be in my lifetime.