seredandfernando-sickoutofluck - feature article susan...

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summer 2005 contexts 27 Contexts, Vol. 4, Issue 3, pp. 27-32, ISSN 1536-5042, electronic ISSN 1537-6052. © 2005 by the American Sociological Association. All rights reserved. Please direct all requests for permission to photocopy or reproduce article content through the University of California Press's Rights and Permissions website, at sick out of luck: the uninsured in america feature article susan starr sered and rushika fernandopulle Interviews with uninsured Americans demonstrate how making affordable health care dependent on employment is leading to fundamental changes in the nature of society. Increasing numbers of Americans enter a deadly spiral of poor health, poor jobs, and inconsistent health care. The uninsured are a new, stigmatized caste in American society. Francine is one tough lady. She has spent her life doing hard physical labor—what she calls “men’s work”—in the tobacco fields and factories of the Mississippi Delta. Today, she is one of the lucky ones: The factory she works in has not yet moved to Mexico or Indonesia, so she still has health coverage. Her sister, Carlene, on the other hand, is not so fortunate. Carlene works as a home health-care aide, taking care of old people. Like many other African-American women in the region, and indeed many people all around the country whose work has moved from manufacturing to the service sector, Carlene can- not find a job that provides health insurance. Carlene has multiple health problems, including a fero- cious, persistent cough. Speaking on her diffident sister’s behalf, Francine declares, “There should be a doctor some- where so when you got no money, you can go to the doctor. There is no free clinic around here.” “So, what happens to uninsured people around here who don’t have any money when they need to go to the doctor?” we ask her. “They are shit out of luck.” During 2002–2003 we traveled to Texas, Mississippi, Idaho, Illinois, and Massachusetts, holding wide-ranging inter- views with more than 120 uninsured Americans and approxi- mately three dozen physicians, medical administrators, and health policy officials. In the course of our travels we met Americans who have seen loved ones die because they did not have medical coverage, Americans who have declared bank- ruptcy or were forced to sell their homes to pay for medical care, and Americans stuck in dead-end jobs because their health is too poor to allow them the career mobility available to Americans of earlier generations. Unlike the health-care systems in most other Western countries, the core of America’s health care is increasingly for- profit, employment-based, private insurance. This system flourished during the post-World War II era, when millions of blue-collar workers held long-term union contracts that guar- anteed health-care benefits, and white-collar workers could expect to remain with—and rise up the ladder of—companies in which they built their careers. In recent years, the connection between employment and
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seredandfernando-sickoutofluck - feature article susan...

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