This week, I want to focus on this piece from Tara Westover, in the New York Times, on her time in college as a poor student and what it says about the ‘American dream’—and what it doesn’t.
The piece is not about healthcare, but it is, too. Westover writes:
The architecture of my life was defined by money, meaning its absence, right down to the alarm blaring at 3:40 a.m. The night shift paid a dollar more, $6.35 an hour instead of $5.35. Never mind that my roommates blasted music until midnight, so that on a typical night, I got around three hours of sleep; never mind that I was dozing through my lectures, or that I spent the entire winter with a raspy cough and string of unexplained sinus infections. It was a dollar more! The math was straightforward and decisive.
My college ambitions nearly came to an abrupt end in my sophomore year. Blinding pain in my lower jaw turned out to be a rotting nerve. I needed a root canal and $1,600 to pay for it. I decided to drop out. My plan was to hitch a ride to Las Vegas, where my brother was working as a long-haul trucker, and to get a job working at the In-N-Out Burger across the street from his trailer.
Then, a leader at my church pulled me aside and insisted that I apply for a Pell Grant, a federal program that helps poor kids pay for college. Days later a check arrived in the mail for $4,000. I had never seen that much money, could not wrap my brain around the amount. I didn’t cash it for a week, afraid of what possession of such a sum might do to me. Then the throbbing in my jaw motivated me to take a trip to the bank. I got the root canal. For the first time, I purchased the required textbooks for my classes. There was money left over, more than a thousand dollars, so I quit the cafeteria and swapped the night for the day shift. I stopped sleeping through my classes; the cough dried up, the infections cleared.
It’s an extremely good example of how poverty and sickness feed off each other. Being sick makes you poor; being poor makes you sick. It’s hard to recover from illness, for example, when you’re sleeping three restless hours a night and pushing your exhausted body to do manual labor every day. Even if you can cope with this, sometimes your body has other plans, and you need a root canal (which you might be more likely to need if you could never afford regular checkups). What then? You’re left with no choice; you have to cash out the tiny investment you’ve been able to make in your future, in escaping poverty, in that “American dream” we hear so much about. Bad luck, try again later.
But as soon as Westover got a little bit of financial security—not some megamillions jackpot, but just a few thousand bucks from a Pell Grant—her “thoughts shifted from obsessively tracking the balance of my bank account, down to the dime, to obsessively tracking my coursework.” It gave her the little bit of extra breathing room that she needed to become a good student, though still “only just,” she notes. Some of the things that made it work for her, like finding a room to rent for $190 a month, are rare or just impossible. And, as she writes, the amount of money needed to pay for college has ballooned since she went in 2004; it’s even harder now than it was then. (See this week’s interviews with healthcare workers on how their loans have affected their lives and careers.)
Poverty made her life very hard, and one of the things that results from a hard life is poor health—her cough that wouldn’t go away, for example. At the same time, actually getting medical treatment is expensive, particularly if you have a high-deductible insurance plan. I thought back to my interview with Chase last year, who worked for a chain sandwich store. He had no insurance, and his physical job was tough on his back. It hurt all the time. But it wasn’t an option to wait for a job that would provide insurance, or even more opportunity to sit down, let alone pay for a program to train for one; the rent was always due first.
It’s a miracle if anyone of even slightly poor health finds their way out of that trap. It’s not glamorous, or an “inspiration,” as Westover said people often tell her—it’s terrible. Suffering like this is not inherently valuable, or necessary, or something we should tolerate in exchange for—what, even? The great joy of being able to charge people for college? What is the advantage to this, other than that it keeps poor people down, and that’s good for those at the top?
Money “frees your mind for living,” Westover writes. But it frees your body, too, from pain and ill health. Just a few thousand dollars instantly upgraded her ability to live her life, in large part because she could afford that root canal. Imagine if we took that financial barrier away for everyone, and paid for every root canal, prescription, doctor’s visit, surgery. We can free people’s bodies from pain and suffering, if we just spent the money on it. Unlike people stuck in poverty, America isn’t too poor to make that investment. We don’t have to choose between paying for root canals and paying for college; yet for some reason, we’ve chosen neither.
In other news:
The Biden administration is still keeping a Trump policy of rapidly deporting migrants, without allowing them to apply for asylum, claiming that the Omicron variant makes this necessary. CBS notes that “U.S. officials have not offered coronavirus vaccinations to most migrants who enter border custody.” The Department of Justice is actively fighting lawsuits against the order in question, Title 42, and has filed motions to dismiss cases by families separated under Trump. As Vox noted last week, the US has chosen not to bolster vaccination support or resources at the border, and has instead “offloaded its responsibility for the health of those it’s keeping in legal limbo onto Mexico.” At least Biden is getting credit with Republicans for all this, though!
In the UK, almost all coronavirus restrictions have been lifted as of a couple weeks ago, with Boris Johnson claiming this would restore our “ancient liberties.” It is true that throughout almost all of our history, British people have been absolutely free to get extremely sick of communicable diseases and die; we have done that over and over again. One of our favorite national pastimes, it seems. With that context: A moving Times piece describes a Covid ward in London, the same ward they visited last year. This time, an unvaccinated patient talks about being unable to see his mother before she died, also of Covid-19, and a young man visits his ailing father, who was vaccinated before getting sick over six months ago. The hospital is also facing a shortage of workers, just like American hospitals.
In California, the Los Angeles Times reports that the city of Santa Ana in Orange County abruptly revoked the permit of the Harm Reduction Institute at the American Addiction Institute of Mind and Medicine. This means the institute has had to “completely stop” providing in-person services, like handing out naloxone. The paper reports that about 70 percent of their clients are homeless, making it much harder for the staff to provide other services, like help with navigating health insurance, over Zoom or the phone.
It seems that the institute was targeted because it’s “the only program in the county providing sterile syringes and disposing of used ones.” The city official who revoked the permit, Minh Thai, wrote that “weekly distribution of syringes to members of the public is not a use consistent with a medical office and/or professional office,” and argued that providing clean needles makes the institute a “counseling” service, which they’re not zoned for. The clinical operations director put it bluntly: “People are going to die” as a result of this decision. This is the sort of thing that happens when you treat homeless people like vermin, treat drug addiction like a moral failing rather than an illness, and treat providing healthcare as optional.
A few good posts this week from Wendell Potter, who I interviewed for The New Republic back in 2020, highlight just how much of the health insurance giants’ revenue comes from the government these days. This is largely due to the growth of Medicare Advantage, the privatized part of Medicare, as well as managed care (yep, that also means privatized) Medicaid programs. Obviously I have no problem with the government paying for healthcare, or spending a lot of money on it, as I’ve argued before; I have a problem with doing it via private companies that must return ever-growing profits to shareholders, whatever the cost to everyone else. I don’t care too much about reducing what we spend on healthcare, but I do care about reducing what we spend on paying private insurers to run government programs, ideally to zero.
One stepping stone to expanding Medicaid in South Dakota has been cleared. Stepped on? I don’t know how to complete the metaphor and I won’t change it now. A bill that would create a fund for paying for expanded Medicaid, should that be approved by voters come November, has passed its first hearing in the state legislature. South Dakota is one of the 12 remaining states that haven’t expanded Medicaid, which means that the state covers far fewer poor people; most don’t cover childless adults even if they have no income, for example, and the income limit for parents varies from 93 percent of the poverty level in Tennessee down to 17 percent in Texas.
Medicare will soon cover over-the-counter Covid tests for beneficiaries. When I first saw the headline, my optimistic little brain thought they were going to use Medicare to pay for everyone’s tests, and scrap the plan to instead have everyone mail a form to their health insurer for reimbursement. But no: It’s just for people actually on Medicare. Duh!
Still no free Bidentests here either, yet, so I bought two Covid tests at CVS yesterday—they’ve got tons, actually—and will be trying to get reimbursed by my insurer. I have downloaded the nine page PDF, which requires me to cut the UPC code off the test and tape it to a piece of paper like the world’s worst school project, before mailing it off to Carefirst. I would love if Carefirst also reimbursed me the 16 cents per page that it’ll cost to print this fucking form at FedEx, but I won’t push my luck. I’ll let you know when I get my $20 back, which probably won’t before the leaves are on the trees here.
And that’s all for today; see you next week.