Contexts, Vol. 4, Issue 3, pp. 27-32, ISSN 1536-5042, electronic ISSN 1537-6052. © 2005 by the American Sociological Association. All rights reserved.
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sick out of luck: the uninsured in america
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