* I’m actually not surprised that healthcare access matters less for the poor. For life-threatening matters, they get access to an emergency room, regardless of whether they “have access to healthcare” in the sense of insurance coverage.
My wife is a nurse and she regales me daily with stories of non-English speakers going to the ER because of very mild fevers or injuries (their pain level is always “diez”), the drug seekers that know that complaining of abdominal pain guarantees Dilaudid, the diabetics that are back in the hospital shortly after having their feet amputated because they’re still not following an appropriate diet, and patients that don’t even pretend to listen while they’re being given instructions about how to use meds, make lifestyle changes, etc to keep them from being back in the hospital.
The hospitals are essentially held hostage by them because they are required to report patient feedback, and if satisfaction scores are poor enough they risk losing federal funding. The “patients” treat nurses like room service – “Nurse, could you get my guests some refreshments?” is an actual quote from a drug seeker that was faking to get opiates – and don’t make any effort to take care of themselves.
These are exactly the kind of people that need social pressure to not be obese, or a drug addict or commit whatever other form of slow suicide.
* A white guy I know in Manhattan is very bright, in his mid-60s, has a lot of physical and psychological challenges (translation: he takes about 15 prescription drugs a day), and hasn’t made a penny of income in nearly 20 years. Yet he gets by. Rent stabilization keeps his apartment (which he’s had since the 1970s) cheap; a disability check gives him enough to pay for the internet and keep him in Subway sandwiches, about all he’s interested in eating; and city medical services pay for most of his doctor appointments and drugs.
It isn’t an enviable life — a new set of underpants or a new shirt is a major expense for him — and he doesn’t even take much advantage of the free cultural life the city offers. But he’s living in his own place in a non-scuzzy Manhattan neighborhood, he’s feeding himself adequately, he’s horsing around on the web, he’s getting his medical needs looked after, and he’s doing it all on basically zero income.
A factor I don’t think I’ve seen anyone raise about life in NYC: you don’t need a car to live decently. That’s a huge chunk of change saved. And it probably doesn’t hurt to be doing more routine walking than most Americans do either.
I sometimes wonder why my acquaintance doesn’t move someplace more friendly and less overwhelming than NYC, but he loves the city, and — who knows — maybe he wouldn’t be able to do as well for himself elsewhere.
(Milking the city’s social system for all it’s worth is something that thousands of New Yorkers are devoted to and often very accomplished at, but that’s another story.)
