Updated

An incarcerated murderer is guaranteed health care, but the victim's family may be among the millions of U.S. citizens who remain uninsured -- and footing the criminal's medical bills.

When convicts are locked up, the Constitution guarantees their punishment won't be cruel or unusual. That means they are entitled to decent food, shelter, clothing and, according to a Supreme Court ruling, health care.

"It's cruel and unusual that forty million Americans are completely uninsured for health care," says Tom Schatz of Citizens Against Government Waste, "and yet prisoners are guaranteed health care under the Constitution."

Prisoners not only have the health coverage some honest citizens lack, but those uninsured taxpayers help pay inmates' medical bills.

Many medical procedures many Americans simply cannot afford are being performed on inmates.

Minnesota recently gave a convicted killer a $900,000 bone-marrow transplant. California spent a million dollars on a new heart for an armed robber, -- and the state will spend twice as much on inmate health care next year than on textbooks for school kids.

Several medical groups are now developing national standards for prison health care and trying to balance Constitutional guarantees with financial realities.

Currently, Texas uses medical residents and video-conferencing to cut costs. Oregon has HMO-style guidelines for inmate coverage.

"What makes no sense to me," talk-show host and former movie critic Michael Medved says, "is that idea that people who play by the rules and lead decent lives should be taxed heavily to pay for top-flight medical care for people who don't."

Court rulings have broadened the definition of what is "medically necessary" for prisoners, thanks to dozens of lawsuits by inmate advocates.

Today, inmates are older and sicker than ever. Hepatitis C and AIDS are rampant behind bars and health care costs account for almost 20 percent of some prison budgets.

"Nobody likes paying for prisoners," said Jim Underdown, of the Center for Inquiry West. "But it's part of the deal in a democratic society, and if you don't like it, there are plenty of countries [that] do believe in cruel and unusual punishment."