What does poverty look like in the United States?
Life inside an ‘American-made’ tragedy
Accelerated by the pandemic, there are uniquely underlying reasons for the growing population of ‘working homeless’ in the United States that starts with inadequate health care. Somehow we have normalized a type of poverty that doesn’t exist in most other countries, including Canada.
January 10, 2021
By: Henry Broeska
Aidan Rosenkoetter seems to have it all. On the outside he’s the handsome all-American boy, the kind mothers dream their daughters will bring home to dinner. He’s now a senior at prestigious Ladue Horton Watkins High School in St. Louis, recently named the top ‘non-selective’ high school in Missouri. He’s been a driven self-starter his whole life and has become an ‘A’ student — even through online pandemic school. A former state football champion, he’s been called a ‘natural leader’ by his coach. It would seem that Aidan’s future couldn’t look much brighter as he reaches college age.
Yes, Aidan is everything a 17-year-old All-American student should be — with one exception. He’s poverty-stricken. Instead of applying to college and looking over scholarship offers with his parents, Aidan’s life has become a monotonous blur of drudgery and suffering, both physical and mental. Here in the heartland of the wealthiest country in the world, what we find unfolding instead is the ‘all-American tragedy.’ And it’s a tale that’s becoming all too common.
Aidan works an average of fifty hours a week at a McDonald’s restaurant. He pulls mostly overnight shifts before logging onto his classes — until he has to go to work again in an unchanging cycle of tedium. There’s no time to do the fun things that kids his age are supposed to do. He grabs minutes of sleep where he can, sometimes propped up in a chair. On payday he hands half of his paycheck over to his mom to help pay the family bills.
Aidan’s mom, Laura has kept their two-person family unit together after the breakup of the family and loss of their comfortable suburban home 10 years ago. Since then, Laura has had to be both mom and dad to Aidan to keep him focused on his future as much as possible. Dad now owes more than $50,000 in support payments that she’s given up on ever collecting. Suddenly thrown into the workforce, jobs for Laura have come and gone. She’s currently delivering meals in a car on its last legs that doubles as their home many nights. Without a permanent address, Laura and Aidan are officially homeless.
To make matters worse, both Aidan and Laura have serious untreated medical problems. Aidan broke a toe at work one night when he stumbled due to fatigue. Laura and Aidan don’t have health insurance. For reasons that are still unclear to Laura, the family was kicked off their Medicaid due to bureaucratic bungling. Aidan didn’t tell his mom about his foot injury because he was concerned that any need to have his toe surgically repaired would stop him from working and bringing in the income they so desperately need. So he continues to work on it in spite of the pain.
Fixing the broken toe comes nowhere close to describing Aidan and Laura’s current healthcare needs. Aidan also has eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus that sometimes causes difficulty swallowing among other symptoms that include fatigue and vomiting. Aidan regularly experiences all three. Once he had to have a small piece of chicken surgically removed from his esophagus in the emergency department at a local hospital. In the United States thanks to EMTALA legislation, anyone can go to any hospital to be treated for a critical injury. But that’s as far as it goes. Once patients are patched up, they are discharged. There’s no follow-up with a doctor and certainly no treatment of underlying causes. Aidan can’t see a specialist, nor can he afford the drugs that would help him.
Laura too has growing health problems. Once blessed with a winning smile, Laura has developed periodontal disease since experiencing homelessness. Without the ability to floss and brush regularly, she’s lost half of her teeth over the past several years.
There’s a high social cost to gum disease which is especially prevalent in homeless populations. Apart from the significant health risk of life-threatening infections, missing teeth reduce self-esteem and dramatically decrease an individual’s ability to eat, get a job, and ultimately return to a normal life. And that’s why Laura is delivering meals out of the public eye. She understands that there’s no way she could pass a job interview. So she continues her heroic quest to keep the family together, passing through society unnoticed, uncared for, unaccepted, inconsequential.
In speaking with Laura, it soon becomes obvious that she’s much more than she appears to be. A college graduate with two science degrees, she had planned to become a physician. Today she talks about her former life as gifted, over-achieving honors student as if it was someone she once knew. “I had a big life all planned out for me. Now I just want to see my son succeed where I didn’t.”
Three or four nights a week Aidan and Laura are able to move from their car to a rented hotel room. This gives them some of the creature comforts of a home and allows them to clean up and take complimentary breakfast meals. Aidan is also able to connect to Wi-Fi and logon to his high school classes without interruption. But not having a permanent address or a credit card has severely hampered their ability to rent an apartment. As Laura says, “It’s a problem for homeless people like us to ever get back to normal.”
Americans are worse off because of a tattered and torn social safety net
Laura says that they are grateful for some of the social safety net protections that they have. For instance, the McKinney-Vento Homeless Assistance Act has allowed Aidan to continue at the top school he once attended as a child of privilege. As she says, “Graduating from Ladue will make a big difference to his further education.”
But in some cases the rug has been pulled out from under them by the same government programs that are supposed to protect them. Laura says, “We were on food stamps but were cut off of both Food Stamps and TANF and when I started my delivery job.” Even though they are still well below the poverty line and homeless, the Supplemental Nutrition Assistance Program (now SNAP, formerly the Food Stamp program) and the Temporary Assistance for Needy Families (TANF) became so restrictive under Trump that they don’t qualify any longer. “Eating hotel breakfasts and a constant diet of McDonald’s food is far from ideal, but without the Food Stamp program we just can’t afford the nutritious food we used to eat.”
Had they lived in any other wealthy country, life today would be much different for Laura and Aidan. Firstly, their medical problems would be treated on an ongoing basis. All other wealthy countries have universal health care programs that cover everyone equally. Aidan would be seeing doctors. He would be taking medications for his chronic EoE that would be paid for. His foot injury would be treated while he collected full wages through other social safety net programs. Even homeless, Laura would have been able to have regular dental checkups and treatments long before her teeth ever deteriorated to the stage she’s at now. Other countries recognize oral health among the homeless as a significant medical complication in heart disease and make sure that care is readily available.
But whether Laura and Aidan would have ever have had to fall below the poverty line and become homeless had they lived in another country is the question. If we use Canada as the paradigm, there are regulations with teeth that enforce spousal payments through garnishment orders. It is unlikely that Laura would ever have gotten into a situation where she was owed $50,000 by her ex-husband.
Social programs are much more generous in other countries too. In Canada, Laura would be eligible for about $6,000 per year in payments through the Canada Child Benefit, plus an additional $700 per month with automatic boosts. Additional grants would be available to supplement that, and additional tax credits are available on any income earned.
It’s not that there aren’t some accommodations in the US tax code. Laura received a tax refund of around $4,000 last year, which included earned-income and child tax credits. But all of the social programs combined don’t come close to Canada’s advantages. In addition, Laura still owes $75,000 on her student loans. Canadian college tuitions, even for medical school are highly subsidized, so she could never have accumulated that kind of debt for the equivalent education.
Most importantly perhaps, if she was living in Canada, Laura’s advanced education would be treated as a national resource. There are multiple programs she could access to either continue her graduate degree or become employed using her knowledge and skills. In fact, it’s very likely that Laura could have continued on to medical school even as a single mom. Canadian Medical School tuitions are a fraction of what they are in the US. Additionally, Canada and most other countries have scholarships, financial grants, financial assistance and generous loan programs that support women who qualify for med school, which Laura certainly did.
Bad health policies increase the income gap between rich and poor
Unfortunately, like many American families living through this growing social disparity crisis, Aidan and Laura will never know that their lives would be much different somewhere else. This is the American-made tragedy that is destined to get worse through the pandemic years. Laura, Aidan, and hundreds of thousands of working poor Americans like them are the tragic consequence of decades of politically conservative social policy choices. To reverse the ongoing increase in economic inequality in America, it’s going to take more than a few tweaks of current programs.
Many poor peoples’ problems start with inadequate health care. Expanding the Affordable Care Act by adding a ‘public option’ as President Biden wants to do, is like sticking a finger in a fractured dike that’s holding back an ocean. Laura rolls her eyes at notion. “It’s simply not going to be enough to help Aidan and me.” The reason Laura rejects the idea of a public option without even seeing a proposal is obvious.
President Biden’s policies do not propose meaningful social reform. He’s afraid that the political barriers raised by the health care industry, including the big insurers are too entrenched. So he’s simply adjusting policy to acquiesce to the political reality that big companies give big money donations to political parties and politicians who fall in line to support the status quo.
Unfortunately, he has it backwards. The politics needs to be modified to achieve meaningful policy reforms like Medicare for All. The proof is in The Bureau of Labor Statistics data. Over 40 million working Americans earn less than $12 an hour, and at the low end of the wage scale employers don’t offer adequate health insurance — or any health plan at all. Minimum wages are so low that simply offering a ‘public option’ wouldn’t allow anyone earning this level of income the chance to purchase a decent health plan under the Affordable Care Act.
Inadequate policy proposals will continue to threaten America
A socio-economic crisis being driven and accelerated by the pandemic is overtaking the American middle-class. There is no equivalent ‘class’ of working poor in Canada or other wealthy countries. If Laura and Aidan were Canadians, their lives would be on much different trajectories, even under pandemic circumstances. In effect, Laura and Aidan are living proof that hard work is not the solution to poverty in America.
If we start with inadequate policy proposals, it will not be possible to make the meaningful reforms that will benefit millions of newly-unemployed or under-employed Americans who are about to cross the poverty line. It leaves us wondering why this needs to be so hard in the United States. Is it too much to expect that we catch up to the rest of the world by helping working Americans get the health care they need and a suitable home to go to at night?
Unfortunately, it is too much to expect. Even under a new administration in 2021, this is what growing poverty among the working class will continue to look like in America. It will be manifest in people like Laura and Aidan as tragically wasted time, unused minds, and vacated educational credentials. Instead of knocking down the doors of innovation and progress, they will continue to exist just inside the few doors that will still be open to them, taking warmth against the cold.
