Living Wages and Health Care: Ramifications of Communication?

By Alana Krivo-Kaufman, Summer Intern at the Kirwan Institute

I was reminded of the book "Nickel and Dimed: On (Not) Getting By in America" by Barbara Ehrenreich as I watched "Sicko”, the Michael Moore movie critiquing our for profit health care system. Policies regarding living wages and health care obviously have huge intersections with race, ethnicity and gender, and disproportionate affects on these populations due to historical discrimination and structural racism. My question is, how should we conceptualize the methodology through which the issues are addressed, and what effect does including, intentionally ignoring, or portraying an issue within a single demographic frame have on the relevant activism, public opinion and therefore policy? And if the two above examples manage to support the implementation of desirable policy, but in doing so skip over the complexities of the intersections, is that positive or negative?

Both works present their issues within the frame work of ‘white America’. In “Nickel and Dimed” the author, a white woman, does an experiential exposé on the situation of the working poor, and chose the demographics of her living and working environments to portray her story in a predominately white setting. The book aimed to strike fear in the heart of the American dream by pointing out a glitch in the system: people work hard forty hours a week, and still don’t get by. Moore’s argument of the dysfunctions within the healthcare system was set up very explicitly by a similar ‘failure of the American dream’ premise, using clips and pictures of a 1950’s picket fence white suburban family, complete with homemaker, breadwinner, and two golden children. This was followed by a stream of insured people, predominantly white Americans sharing compelling stories of their healthcare woes. (The film does include one African-American woman, as well as an inter-racial couple questioning if the husband would have received the same denial of coverage were he a white man, but they are definitely outnumbered.)

The back cover of “Nickel And Dimed” describes the book’s message as "inspired in part by the rhetoric surrounding welfare reform, which promised that any job equals a better life". Within "the rhetoric surrounding welfare reform”, race is necessarily a factor, either explicitly or implicitly, in description, in statistics, or in public conception. Yet, the book is a one subject piece on the job and life prospects as experienced by a white woman author, which does not portray any structural racism within the system of low income or unskilled jobs, or discrimination and profiling within the system. The health care system is similarly portrayed by Moore through the lens of white Americans, critiquing the underlying flawed system of U.S. health care in a general way, but not really exploring any skewed racial connotations of that system.

Affecting policy implementation is tricky and requires attention from multiple perspectives, including analysis and communication. Neither Moore nor Ehrenreich’s work openly strives to weaken OR address structural racism or discrimination within any of the systems they focus on. They simply point out broader all encompassing flaws within healthcare and non-living wage low skill jobs, and what we expect from them. Avoiding directly addressing issues of race was a deliberate move on both parts, but does this hinder or help policy in the long run? If a story has to be told from a white perspective to garner sufficient attention, does using those modes of communication necessitate the use of the same approach in the future and further disempower people, or is it simply a good way to get things done?