Sally Heimann, CRNP, whose project “Class and Health Care” is an RFP Winning Project,  wrote a reflection on the series of interviews she conducted over the past two semesters. To hear more about Ms. Heimann’s experiences and listen to the actual interviews, attend the Culmination Extravaganza, Monday March 19th, 5-6:30pm in the Campus Center Main Lounge.

When I first conceived of this Class Dismissed? Project, which I originally called Socio-Economic Status(SES) and Its Affect on Health Care Among Members of the Bryn Mawr College Community,  I thought about the barriers to care based on insurance and cost issues. There is plenty of research which supports the notion that people with lower incomes fare worse in health standards in the U.S.

But the project was meant to be about class, not specifically SES, so I renamed the project Class and Health Care.  “Class” is a more amorphous issue than is determined by insurance coverage or income alone.  Class is not just socio-economic status, race, education or income.  It is, instead, some amalgam of factors that is very difficult to pinpoint.  It changes over time and varies across populations/subgroups.  Reading the book Class Matters? helped me broaden my thinking as I prepared for the interviews.

In the end,however, all but one of the people who volunteered to tell their stories chose to do so because of having had the experience of being without health insurance.  The stories they related were all based on issues of insurance and difficulties managing the health care system based on financial issues.

And yet, all of the interviewees described an ability (either they themselves or their parents) to negotiate the health care system.  Because of their educational backgrounds, their connections with people in power or some sense of entitlement, they were able, for the most part, to obtain the care they needed.   I believe that ability distinguishes them from “lower” class individuals.  For those in the lowest classes, that access and wherewithal is simply missing.

This isn’t to say that the interviewees all had an easy time of it.  Far from it.  Yet, although everyone who was interviewed categorized themselves as middle-middle or lower-middle class, in some ways they could be classified as upper middle class.  By virtue of their educational background, their connections with people in power

Everyone was convinced that others on campus were at a higher economic level.  That may be true, to some extent, but health care, or the access to it, is an invisible commodity or privilege.  Someone who might appear affluent on the outside, by virtue of clothes and other material goods, may, in fact, be balancing on the precipice of financial ruin because of a lack of health insurance.

I guess in the end, one of the lessons is, never assume