Republicans routinely deny the existence of class in America. Class may be less visible than it once was, but it’s still here and it still matters. (More)

Class Matters, Part I – Distinctions

This week Morning Feature will look at Class Matters, a compilation of articles from a 2005 series in the New York Times. Today we’ll explore distinctions of class and how they affect our health. Tomorrow we’ll discuss directions of class, how class impacts our decisions and their outcomes. Saturday we’ll conclude with destinies of class and whether Horatio Alger stories are still possible in reality.

Does class still exist?

Last November, newly-elected Sen. Rand Paul (R-KY) said class doesn’t exist in the U.S.:

Well, the thing is, we’re all interconnected. There are no rich. There are no middle class. There are no poor. We all are interconnected in the economy. You remember a few years ago, when they tried to tax the yachts, that didn’t work. You know who lost their jobs? The people making the boats, the guys making 50,000 and 60,000 dollars a year lost their jobs. We all either work for rich people or we sell stuff to rich people.So just punishing rich people is as bad for the economy as punishing anyone. Let’s not punish anyone. Let’s keep taxes low and let’s cut spending.

Last month, Sen. Paul revived that argument. Quoting from a Heritage Foundation paper showing that even poor Americans usually have homes, cars, and consumer goods, Sen. Paul argued that “poverty is not a death sentence,” that most poor people escape poverty, and that the health effects of poverty are due mostly to behavioral decisions such as smoking, diet, and exercise.

Statistics and lives

There is some truth to Sen. Paul’s claims. In their research for Class Matters, the Times reporters found that many traditional indicators of class are no longer reliable. Lower prices, mostly due to cheap overseas labor, and wider access to credit cards have enabled even chronically poor Americans to buy consumer goods that used to denote at least middle class standing. And because people often fall into temporary poverty due to divorce, job loss, or serious illness, a snapshot of Americans below the poverty line in any given month will include many who still have homes, cars, and other middle class amenities. Many will get back above the poverty line – although often only after bankruptcy and foreclosure – so the statistics show that most poor Americans don’t remain poor.

Yet such statistics obscure as much as they reveal. Let’s take those health effects, for example. Heart attacks are common in New York City, but Times reporter Janny Scott followed the stories of three heart attack patients and found that class influences both treatment and recovery. All three heart attacks happened in the summer of 2004:

Jean Miele, Architect

Jean Miele was walking back to work after a several-hundred-dollar sushi lunch when his heart attack happened. As Miele collapsed on the street, his upper-middle-class colleagues immediately recognized he was having a heart attack and called for an ambulance. His heart attack happened in midtown Manhattan, and he had his choice of premier hospitals. Within minutes of his arrival at Tisch Hospital, part of NYU Medical Center, Miele was in a surgery room awaiting angioplasty to unclog his coronary artery. His ventricular fibrillation was treated immediately. Less than two hours after his collapse, Miele’s artery was reopened and a stent inserted.

Miele was released two days later and went home to Brookhaven, where his wife scheduled medical appointments, got his prescriptions filled, helped him change his diet, and dealt with the insurance companies. He enrolled in a three-month monitored exercise program, covered by his insurance, and found a cardiac rehab center ten minutes from his home. He took the summer off from work, then negotiated a retirement deal with his partners. A year later, Miele was healthier and happier than he’d been before the heart attack. He had more time to spend with his wife and adult children, and more time to spend in his garden and restoring old Jaguars in his garage. His doctor put his recovery in the top 1%.

Will Wilson, Utility Worker

Wilson hoped he was having only indigestion after a big meal, although he’d had a heart attack before. His fiancée insisted on calling an ambulance, and he had his choice of two Brooklyn hospitals. Neither was licensed to do angioplasty. He was given a drug to break up the arterial clot, but when the clot reformed the next morning, Wilson was transferred to a Manhattan hospital. He underwent angioplasty, but the lost hours meant dead tissue in all three main areas of his heart. He spent five days in the hospital and went home to Brooklyn.

Wilson had quit smoking and drinking after his first heart attack, but found it harder to control his diet. He’d grown up on fried chicken, pork chops, and macaroni and cheese, and family members still served those foods at get-togethers. His fiancée found it hard to find fresh produce and fish in their neighborhood. He tried to stick to salads, even when he and his new wife went to Red Lobster. But he still ate a few fried shrimp. Like Miele, Wilson began a monitored exercise program. But his was rehab center a long drive or a subway ride away in Manhattan. Still, he stuck with it. A year later, Wilson was recovering fairly well and looking forward to retirement a few years down the road.

Ewa Ryzczak, Nursing Home Maid

Ryzczak wasn’t sure what her illness was, even weeks later. When she finally agreed to let her husband call an ambulance, they took her to a city hospital. A triage nurse classified her as stable but high-priority, and only two hours later did doctors examine her and discover she was having a heart attack. She was given drugs to stop the coronary clotting, and the next day she was transferred to Bellevue for an angiogram. But she came down with a fever and the angiogram was put off. She spent two weeks in the hospital, receiving treatment for an infection, before being sent home. The angiogram was never performed.

A Polish immigrant, Ryzczak spoke little English and did not understand what had happened until her first follow-up appointment, where the doctor patiently explained that most of her heart muscle was dead. He said an angiogram at that point would be pointless; she needed to quit smoking, improve her diet, and exercise regularly. She and her husband had only a single room; they shared a kitchen in their rooming house with other families who still loved fatty Polish food. She found it difficult to cook separate meals for herself. And her husband and friends all smoked, making it harder for her to quit.

Ryzczak had no car and could not afford taxis. Between bus and subway rides, follow-up visits to doctors consumed entire days. And there were lots of doctors, for it was as if her heart attack had triggered a cascade of other problems. A growth on her adrenal gland. An old knee injury that now needed surgery. She finally quit smoking with the help of a hospital program, and gained weight because she no longer got the exercise of her work. Her doctor suggested an exercise program like that Miele and Wilson had attended, but Ryzczak found it hard to schedule and let it slide. A year later, her doctor described her as “a full-time patient.”

Distinctions

The distinctions in these stories were about more than money. It’s easy to criticize Ewa Ryzczak’s choices, point to Jean Miele, and say “If you did what he’s doing, you’d be healthier.” But Ryzczak didn’t have an upper-middle-class support network, from a choice of the best hospitals in New York to a well-educated wife who was willing and able to take care of the details and support his choices. Few wealthy or upper-middle-class people smoke, so there is both less peer pressure to start and more support to quit. Miele had a vegetable garden, and local markets with a wide variety of healthier foods. Wilson’s wife struggled to find fresh vegetables and good fish. Ryzczak did not even have her own kitchen. For Miele, cardiac rehab was ten minutes from home. For Wilson, it was an hour or more drive or a subway ride. For Ryzczak, it was a combination of bus and subway transfers so daunting she gave up.

On the one hand, Sen. Paul is right: many of those distinctions are about choices. But class affects the choices you have available … and the penalties for your mistakes. We’ll discuss that more tomorrow.

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Happy Thursday!