A worker with pain, without insurance

"I don’t want to get shit on every time I want to get help."

Even reaching for sandwich toppings hurts Chase’s back. (Photo by Frederic J. BROWN / AFP) (Photo by FREDERIC J. BROWN/AFP via Getty Images)

Note: This post has been updated to remove some identifying details.

Last week, we heard from Lee, a Virginia man whose complicated spinal surgery came with a demand for a $7500 up-front payment—leaving him with the choice to come up with the cash, or delay his surgery and prolong his pain. This week we’re returning to spines with Chase, a 25-year-old man whose work in manual jobs has aggravated his pain.

Chase is a graphic designer by training, but has worked a number of restaurant and retail jobs to get by, like Pizza Hut, Walmart, and most recently Jersey Mike’s, the sandwich chain. He has spinal scoliosis, a condition where the spine is curved to the side. Here’s an x-ray of his spine, shared with permission.

His condition means that small movements can cause him significant pain. At Jersey Mike’s, Chase said, even reaching for sandwich toppings hurt. His various jobs have given him varying opportunities for relief at work; at Pizza Hut, at least he got to sit down when he was delivering orders in his car. Working retail is a dangerous field, with a high rate of workplace injuries—mostly “sprains and strains,” and “general soreness and pain.” (And that’s are just cases where a worker missed work because of the injury; those statistics say nothing of workers who toil through the pain.)

These jobs didn’t provide health insurance, he said. He estimates he’s seen a primary care doctor once in the last four to six years. He saw a chiropractor when he was insured, but couldn’t afford to keep paying the co-pay over and over. Those co-pays add up when you’re trying to go to a physical therapist or chiropractor several times a week for a long stretch, as they recommend. (In the past few years I’ve spent hundreds of dollars on three different attempts at twice-weekly physical therapy for migraines, all while insured with ‘good’ employer-provided insurance. It adds up fast.)

An important part of our conversation that I’d highlight is how difficult Chase has found it to pursue non-employer-based options for his health insurance. He told me he struggles with anxiety, and dealing with things like enrolling in the ACA marketplace or Medicaid have been a problem for him. Even when he did have Medicaid, he said, he couldn’t find a doctor in-network near him—meaning he went through the bureaucratic hurdles and stress of signing up to basically no avail, save being covered in an emergency. At the end of a day’s work, he’s “sapped of energy” from putting up with back pain. Regardless of coverage, he didn’t have time to see a doctor anyway.

Chase’s story is one of millions of examples in this country of how health justice can’t be achieved just with insurance coverage or ‘access’ to healthcare; it means good jobs that pay well and provide time off for healthcare needs, and decoupling insurance from employment entirely. Think of what Chase said about insurance: He’s never had a job that provided it, but felt like he should be grateful just to be able to pay the rent. It’s a sick society that inculcates that sort of shame and self-doubt about taking care of oneself, especially in someone with a health condition. There are millions of people out there who work despite being sick or in pain, as well as those who work because they’re sick and need insurance, or just to pay medical bills. Shitty jobs shorten lives and fill them with misery, too.

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Since I interviewed him, Chase told me he got the new job he mentioned—which he said still doesn’t provide health insurance, but he likes it a lot otherwise, and he said he will get insurance through his wife’s job in April. (He also got Covid-19, but recovered.) He kept the job at Jersey Mike’s for nights and weekends for a while, but has since dropped it. He’s also seen a chiropractor again, to no avail: “I recently messed it up cleaning […] but my back is slowly but surely recovering from that. Went to a chiropractor a few times, but saw no noticeable improvement. They don't wear masks either. It's really lame that the thing that ails me the most has the highest association with grifters, medically speaking.”

Our conversation has been condensed and edited.

Chase: I’m a graphic designer, and for a long time, I’ve always known I had scoliosis. Which, you know, hurts a lot. But more importantly than that, I discovered it in kind of a rough way. I’m from Chattanooga, Tennessee, that’s where I’m at right now, and I went to a chiropractor’s place because I actually had insurance, I figured I could spend $40 to see how my back was doing, even though I worked at Pizza Hut at the time and I could have told anybody that my back wasn’t doing great. I decided to go, and before the x-rays even got processed, they were just watching how I walked up and down the hall out of nerves, and they were like, you’re walking in a way that shows you have scoliosis. And I was like, you can just tell? That blew my mind, especially in somebody who doesn’t go to a doctor regularly, doesn’t have insurance. So they just called that one. Moments later, of course, I get a picture of my spine, and it literally looks like a Chinese dragon, it looks like it’s curving up as it goes through my lower back. It’s pretty gnarly.

From there, I’ve kind of always known that my back’s messed up, and I’ve always known there’s not a lot I can do about it. They prescribe, hey, come back to us twice, three times a week for three months—and that’s cool, if I had a spare $3000 lying around. But that’s just not the case. So I got a foam roller. Getting myself to do that after a tough day was one thing, but I’m starting to finally listen to my now-wife who’s telling me, hey, maybe you should foam roll. That’s starting to help out finally now. I’m also figuring this one out too, going through a list of problems I have when it comes to focus and conversational cues, I’m starting to think that I might also have ADHD, I was diagnosed as a kid with anxiety. It makes sense in my head, going back over it, of course I didn’t have the motivation to foam roll, I didn’t have the motivation to help myself in a lot of ways. [...] It’s like a mental thing where, I should have been doing it the whole time. 

Sick Note: You said you’ve been working in a restaurant?

Chase: I’m from a suburb of Chattanooga called Ooltewah. Back originally when I was here, I worked at Pizza Hut and it was fine because I actually got to sit down quite a bit. If deliveries were coming in, I get to sit in my car. Not bad. But Pizza Hut doesn’t pay the bills. A friend of ours, he was a mutual friend of my now-wife, then-fiancée. I had met him through her. Eventually one thing led to another and he was like, hey, my family didn’t want to move into this house that I’m paying a mortgage on, do you guys want to come here to Virginia? 

The mutual friend tosses me a position at a used car place, moving cars around. Which was fine, but I was working for an asshole, and I got stressed out so bad that I kind of broke down crying, and he kind of ended up quitting after that happened. [My friend] was like, ok, cool, I’ll throw you another job. He gets me a position at [a flooring company]; one of the best jobs I’ve ever worked, because they paid some of the best and I got to sit down during most of it. No healthcare at all at those places, I wouldn’t expect that. Before even moving, I worked Cracker Barrel, I worked Walmart, I worked a bunch of different jobs where I was on my feet most of the time. They did not care about my back. Even though I worked long enough to be a salaried employee at [the flooring company], almost two years, no healthcare, nothing like that. I even provided someone else’s commission; he let it slip that they actually do commissions and I didn’t even know it. So every sale I made, he made money off it.

Just a long history of—I know my back’s messed up, and whether it’s even finding a job, or having one and just being thankful that I have one; it doesn’t really leave me in a position to go, well, now I want healthcare. Because it’s like, you should be happy you’re even paying the rent.

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Sick Note: Have you ever tried to get a plan on the Affordable Care Act exchange or looked at signing up for Medicaid or anything like that?

Chase: Yeah, I checked out the ACA stuff, the Obamacare page. It was closed—I checked that back a couple months in, every other month I’d check and it’d still not have anything open. I ended up getting Medicaid, I got Aetna Better Health from Virginia, and my experience with them was that they had really nice customer service and everything, but there really wasn’t a doctor in their network near me, and there was no way to check confidently which doctors—the work of cross-referencing which network for Medicaid had a doctor near me that would accept it, before signing up for it, in the specific windows they needed me to, was tough enough to where I was like, ok, I’ll take this one. This one seems to have good benefits. I never use any of the benefits, I never even got a chance to visit the doctor just because I didn’t have time. I couldn’t navigate all that. It’s always been one of those things where I’ve had the kind of nervousness of actually taking care of myself in a way that’s productive. 

Sick Note: I hear you, they make it really hard. 

Chase: For no reason!

Sick Note: How long have you been back in Tennessee?

Chase: We moved last month, early last month. [Sick Note: This interview was conducted in December.] We packed up everything. Now we’re currently living with [my wife’s] sister—we’re recently married, we got married two months ago—we’re living with them, trying to build up some money so we can get our own place. 

Sick Note: The job you’re working now, presumably no health insurance?

Chase: Nope. I work in a Jersey Mike’s. I’m very thankful for the job, that was a hookup from my now brother-in-law, but I’ve been applying to other places full-time. Thankfully, things are starting to turn up my way—there’s a State Farm office that sells insurance, they said they want to see me back in there tomorrow. So maybe I might pick up something, and maybe I might actually get insurance, because that’s literally what they do. Otherwise it would be extremely ironic to have me selling insurance to somebody and not have it. 

Sick Note: Since you had Medicaid in Virginia, when you moved to Tennessee did you think about trying to sign up for it then?

Chase: Between everything else going on, I’ve certainly thought about it, and I just need to do it. But it’s one of those things where I’m juggling a bunch of other stuff. I’ll make sure to actually go and open a tab now. I feel kind of embarrassed. 

[...] It’s one of those things where I didn’t even have a chance to look into it yet, and having the tab open that says TennCare is already making me feel a little anxious, because I can just tell it’s going to be a fucking nightmare. 

Sick Note: You mentioned your job causing you pain. How does the work you do affects your scoliosis and how does it make you feel? 

Chase: Remember I was saying Pizza Hut ended up being nice because I got to sit down? I have never felt worse at a job than even just an average-slow day [at Jersey Mike’s]. It all stacks up. It sounds so embarrassing to me but it’s a reality that I face, where just grabbing toppings for a sandwich, that slight bend over that you do literally like 10-15 times per order, is just enough for me to be like, oh, my back is going to pop like a firecracker as soon as I get on my foam roller. It really makes me feel sapped of all energy, just totally fatigued. Just something as innocuous as that. 

And the fact that every workplace, every restaurant that has a freezer has to stack boxes in the most ‘efficient’ way, which is almost always in a corner, or you have to lift it in a fucked up way, and there’s no one to talk to about that, of course. There’s no open communication of like, hey, you should fix that, because it’s like, no, dude, it’s a restaurant, everybody wishes everything could be fixed, but ‘corporate’—that’s always the answer, nothing gets up the ladder because there’s no ladder to get up. 

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Sick Note: Can you remember the last time you saw a primary care provider, like a normal doctor? 

Chase: The last time I went to one? … Gosh. It must have been three years ago, when I thought I had the flu and I had to spend $100 to go to an urgent care place. Before that, another two, three years. 

It’s just, I don’t want to get shit on every time I want to get help. I don’t want to have a fucking dumpster fire of a bill every time I feel like I’m sick, even though that’s exactly what—every time you feel sick, you should be able to be like, hey, I feel fucking sick, please help? And someone should be able to be like, yeah, you’re fine. And I shouldn’t have to go, ah, fuck, I’m fine? That sucks! That sucks so bad, when I feel almost equally bad regardless of the result. I feel bad if I’m fine because I wasted money? That sucks. If it turns out that I actually am sick, well great, at least now there’s a next step other than, you wasted money, got ‘em. I have student loan debt too, like everybody does apparently, that’s a cool thing that no one told me when I signed up for that. It’s just a hundred little things like that where we’re all living with a shitty dark cloud over our heads. Any time I want to complain about healthcare, it’s just a room full of people nodding and also unsure of what to do.