Table Of ContentUNINSURED
IN AMERICA
UNINSURED
IN AMERICA
LIFE AND DEATH IN THE
LAND OF OPPORTUNITY
SUSAN STARR SERED AND
RUSHIKA FERNANDOPULLE
UNIVERSITY OF CALIFORNIA PRESS
BERKELEY LOS ANGELES LONDON
University of California Press
Berkeley and Los Angeles, California
University of California Press, Ltd.
London, England
© 2005by the Regents of the University of California
Library of Congress Cataloging-in-Publication Data
Sered, Susan Starr.
Uninsured in America :life and death in the land of
opportunity / Susan Starr Sered and Rushika Fernandopulle.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-520-24442-7(cloth :alk. paper)
1. Medically uninsured persons—United States.
2. Insurance, Health—Social aspects—United States.
3. Insurance, Health—Economic aspects—United States.
4. Health services accessibility—United States. 5. Right
to health care—United States. 6. Social classes—Health
aspects—United States. 7. Marginality, Social—Health
aspects—United States. 8.Working class—Health and
hygiene—United States.
[DNLM:1. Medically Uninsured—United States.
2. Health Care Reform—United States. 3. Insurance,
Health—economics—United States. 4. Medical
Assistance—United States. 5. Socioeconomic Factors—
United States. W 250AA1S483u 2005]
I. Fernandopulle, Rushika J. II. Title.
RA413.7.U53S47 2005
362.1′04252′0973—dc22
2004022033
Manufactured in the United States of America
13 12 11 10 09 08 07 06 05
10 9 8 7 6 5 4 3 2 1
The paper used in this publication meets the minimum
requirements of ansi/niso z39.48–1992(r1997)
(Permanence of Paper).
We dedicate this book to the uninsured women and
men who shared their experiences with us and
trusted us to do our best to make sure that their
voices are heard.
CONTENTS
ACKNOWLEDGMENTS \ ix
Prologue: Loretta and Greg’s Story \ xv
Introduction: The Death Spiral \ 1
1. From Working Class to Working Poor:
The Death of Industry in America’s Heartland \ 21
2. Medicaid, Welfare Reform, and Low-Wage Work
in the New Economy \ 40
3. Family Matters: Divorce and Domestic Violence \ 57
4. Who Cares for the Caregivers?
Love as a Portal into the Death Spiral \ 72
5. The Fox Guarding the Henhouse:
Work-Related Injuries and the Vagaries
of Workers’ Compensation \ 86
6. Risky Business: The Self-Employed, Small Business
Owners, and Other American Entrepreneurs \ 107
7. Young, Sick, and Part-Time: The Vulnerability
of Youth and the New American Job Market \ 122
8. Mental Health Matters: A Mexican Immigrant Hits
the Bureaucratic Wall \ 140
9. Race Matters: Health Care Stories
from Black America \ 152
10. Descent through the Death Spiral \ 163
11. Moving Forward \ 184
Appendix 1: A Primer on the U.S. Health Care System
and the Safety Net \ 195
Appendix 2: Resources for Health Care \ 205
NOTES \ 207
BIBLIOGRAPHY \ 217
INDEX \ 233
ACKNOWLEDGMENTS
This book was jointly conceived by Susan Sered and Rushika Fernan-
dopulle. Susan conducted most of the fieldwork on which the book is
based and is the primary author of chapters 1through 10as well as the
introduction. Rushika is the primary author of chapter 11and appendix
1and has contributed medical and policy expertise at each stage of this
project. John Mihelich co-authored chapters 1and 5.
SUSAN SERED WRITES This book was truly a collaborative effort.
At each fieldwork site, local scholars and activists worked with me to
identify interviewees, understand local variations and conditions, and
make sense of the huge amount of information gathered. Many of these
local research associates became fast friends over the course of this proj-
ect, and for that I am truly grateful.
In Idaho, Debbie Storrs and John Mihelich, professors at the Uni-
versity of Idaho, were my guides to Idaho culture, society, and econom-
ics. (We also had a lot of fun visiting local bars together!) John was kind
enough to read numerous drafts of the manuscript and spent countless
hours brainstorming with me. His insights into the restructuring of the
American economy and the changing nature of blue-collar work appear
throughout this book. Working with Debbie and John has been one of
the very best parts of this project. I also wish to thank Sharon Connors,
ix
director of Social Services for Shoshone County, for her clear explana-
tions of the county public aid system; Terri Sterling of the Idaho Com-
munity Action Network for her important insights into what it means to
scrape by in Idaho; Dale Bates of the Benewah Medical and Wellness
Center in Plummer for his hospitality; Frankie Yockey and Ila Burch for
helping us network in Troy and Orofino; and members of the Read to
Me Coalition in Orofino for their open, honest, informative, and enthu-
siastic conversations.
In Mississippi, Lynne Cossman, professor at Mississippi State Uni-
versity, and Melody Burrage, a graduate student at MSU, traveled with
me through the Delta, Meridian, and Starkville regions. Their deep
knowledge of southern society, together with their patience and good
humor, was indispensable. Lynne helped me work through repeated
drafts of the manuscript, providing sociological insight and close atten-
tion to details. Thank you! I also wish to thank Robert Cadenhead, chief
executive officer of Kings Daughters Hospital; Robert Bell, executive
director of Delta Health Ventures; George Scheiderman at Deporres
Delta Ministries; Bishop Dennis E. Huggins Jr., senior pastor of the
First Apostolic Church of West Meridian; and Kathy Tentinto at the
Good Samaritan Medical Center in Columbus for taking the time to
share their thoughts and experiences.
In Texas, Maria Luisa Urdaneta, a nurse and professor of anthropol-
ogy at the University of Texas in San Antonio, served as tour guide, cul-
ture broker, interpreter, colleague, and friend in the Rio Grande Valley.
Her hospitality, encouragement, and vast knowledge of Mexican Amer-
ican experience have been vital to this project. I particularly want to
thank the wonderful women of ARISE (A Resource in Serving Equality)
who introduced me to their community and to their important work on
behalf of Mexican Americans in south Texas. I also wish to thank Car-
men Boudreau at the Brady Green and Yolanda Santos at the Good
Samaritan Center for sharing their keen knowledge of health care issues
in San Antonio.
In Illinois, Claudia Lennhoff and the Champaign County Health Care
x ACKNOWLEDGMENTS
