Journalist Sarah Jones on How the U.S. Healthcare System Treats People Like They’re Disposable (Q&A)
“People are showing up to town halls and yelling at Republicans for a reason.”
“For too many people, misery is the formal policy of the United States,” begins Disposable: America’s Contempt for the Underclass, published this year by Sarah Jones. In the deeply researched book, Jones illustrates how in the United States having a health problem can damn you to poverty, struggle, and avoidable death. Jones was motivated to write the book after her grandfather died of Covid-19 and she focuses on the Covid crisis to examine how our economic and healthcare systems render poor and working people disposable.
The ideas in the book are more relevant than ever now that the Trump administration has cut roughly $1 trillion from food assistance and Medicaid over the next decade, and Congressional Republicans have shut down the government rather than agree to Democrats’ condition that they preserve subsidies for ACA insurance plans – without which roughly 22 million Americans will be forced to pay dramatically more for healthcare premiums or lose their insurance.
Jones is a staff writer at New York Magazine, a frequent contributor to Dissent, and one of my favorite living writers. We talked about class distinctions, Jeff Bezos, MAHA, and how organizing really is the only way out of this.
Meaghan Winter: I’m used to reading about problems with our healthcare system in terms of equity, equality, or fairness. Why did you frame your book around the idea that there’s an underclass that’s disposable?
Sarah Jones: Concepts of equity or equality are very important, and they do appear in the book. But when we’re talking about inequity, what does that mean on a human level? When a society is stratified, and that stratification is enforced, we do end up treating people like they are disposable. It’s just a natural consequence of structuring society in that way. We can go back centuries and see that in action, but Covid really made clear that there are life and death stakes attached to inequity.
You can put it in much simpler terms. When we say we “treat people like garbage,” what does that mean? We dispose of garbage.
Meaghan: Throughout the book, you illustrate how in the United States the line between being middle class and living in poverty can be completely collapsed by one health emergency because we don’t have guaranteed healthcare. After reporting the book, is there something that stands out to you about that?
Sarah: It was important to me to get across that these class distinctions – which, for good reason, permeate our conversations of inequality in the US – are really porous. Our foundational American myth says that if you work hard enough in the United States, you’re gonna climb up the ladder and you will be secure, right? You’re gonna enter the gated neighborhood, you’re gonna be like Donald Trump.
In fact, it’s important for people who think of themselves as middle class to realize that materially they are much closer to people who are working class or poor than they are to somebody who’s as wealthy as Donald Trump, because that’s the reality. When we’re not honest about that situation, it’s much easier for a figure like Trump to come in and say, “Don’t you want to be like me?” But in fact, that’s not how it works in the United States, and that’s not how it’s ever worked.
Since I wrote the book, and since Covid, the Bernie Sanders campaign, and the popularization of Medicare For All, there’s been more questioning of the way we do healthcare in this country and who has access to it and who doesn’t.
Everyone at some point interacts with the healthcare system, and unless you have really good health insurance your entire life or you’re independently wealthy, chances are pretty good that you’re going to have a negative interaction, or you’re not going to get the care you need, or you’re going to have to delay getting care you need for financial reasons.
I don’t think we should be confused by why people are angry. People are showing up to town halls and yelling at Republicans for a reason. Does that mean that, you know, Medicare for All is imminent? I don’t know about that, but I do think people are ready for change, and I think they’re ready for it in a really transformative and even radical way.
Meaghan: After doing all this reporting, what stands out to you in terms of how money in politics makes an underclass disposable?
Sarah: Amazon and Jeff Bezos come to mind. As I write about in the book, the Covid crisis further enriched Bezos while the people who were working in Amazon warehouses were not making a lot of money.
I don’t think a lot of people really understand the physical toll working in a warehouse takes on your back, on your joints. People told me it was very difficult, if not impossible, to socially distance in the warehouse. They didn’t always have the protective gear that they needed to try to stay safe or to clean their workspaces. So, all that was going on while Bezos was getting richer and richer than ever.
That culminates in his more explicit rightwing turn as he’s getting closer and closer to Trump. The outrage over his wedding in Venice this summer interested me because I saw it as possibly a deviation from this tendency, which is elevated by the rightwing in particular, to consider Bezos or Trump as someone to emulate. I think there’s a growing recognition that no one needs to be as rich as Jeff Bezos. And in fact, it’s really hard to have a healthy democracy when somebody like Bezos can buy influence, and he’s doing that on the backs of workers.
Meaghan: The problems with our healthcare system feel so intractable right now. What can we do as individuals or organizations?
Sarah: Sometimes I worry it’s a little trite to say, “Organizing is our only way through,” but I also think that it’s true. We can look at those movements for disability rights, for labor rights, for welfare rights and draw really important lessons. One conclusion that I really wanted people to reach by the end of Disposable is that being disposable has never meant being passive.That’s why it was so important to me to write about labor and the organizing work that people with disabilities have undertaken.
When you’re disposable – or even if you’re middle class and you’re worried about becoming disposable – you can’t purchase proximity to Trump, your only option really is to band together with other people and make yourselves very difficult to ignore. And there’s a pattern of that working over and over and over again. And so, I think that really is the only way forward.
Meaghan: How do the ideas in your book relate to the Make America Healthy Again (MAHA) agenda?
Sarah: The book was complete before Trump won in 2024, but I’ve been thinking a lot about MAHA and RFK Jr. I’ve been spending a lot of time thinking about: How do you talk to a person who’s wrapped up in conspiratorial beliefs about vaccinations, scientific research, antidepressants and other medications during pregnancy? You know, I don’t think anyone has a great answer for that, but I don’t think you can really figure out what’s going on with MAHA unless you think about why many people distrust institutions.
We’ve talked about the negative interactions people are having with the healthcare system. So, is it so crazy that people don’t think it’s working for them? But how do we address that without conceding ground on some really important areas such as vaccination and public health?
It brings us back to this notion of solidarity again. MAHA has really benefited from individualization. It’s driven by an emphasis on personal choice, this sense of, “I’m going to do my own research,I’m making the choice that is best for me or my child, I’m not going to think about the implications of that choice in a broader societal way.” When someone doesn’t vaccinate their child, that has public health implications, right? And so, for me, it’s really about: How can we get people to care about other people?
That’s really difficult. I think organizing is part of that, but also, what would it look like to hold pharmaceutical companies accountable? How do we talk about science and healthcare without sacrificing scientific integrity? We also have to contend with the fact that there has been a really systematic, well-funded, concerted attack on science and scientific research that has a lot of big money behind it. How do we make sure these big companies can’t just do whatever they want?
Meaghan: With so much happening, how are you coping?
Sarah: My New York Magazine beat right now has focused really heavily on conservative politics and Christian nationalism. I love doing it, and at the same time, it does mean wading through some of the worst garbage online day after day. I’ve been struggling to figure out exactly when to turn off that part of my brain, which may be just a function of politics right now.
I’ve been reading a lot. I grew up evangelical Christian, and during my childhood, any question that you might have, any problem you might be experiencing, could be solved by going to the Bible. I don’t mean to denigrate anyone’s faith, but I’m not a Christian anymore, I don’t go to the Bible to solve my problems, but I still go to books.
I’ve been joking with a friend about going off grid to raise our kids somewhere. There’s this desire for separation. I think that’s an understandable impulse, but at this moment, it’s perhaps not compatible with my political views. So, I don’t have this great succinct answer, I’m still trying to figure it out, and I’m trying to become a little more comfortable with ambiguity and uncertainty.