The “Other” Within: Health Care Reform, Class, and the Politics of Reproduction

The Article explores the nation’s resistance to developing a more equitable system of health care coverage. It does that through reference to the nation’s peculiar class system. Americans contend that anyone can avoid poverty through hard work and responsible choices. Yet, in fact, class mobility is the exception, not the rule. Americans are deeply anxious about safeguarding relative class status, but the signs through which they assess class are murky. In measuring their own socioeconomic status in relation to others, Americans consciously look to a wide set of elusive, shifting status symbols. Less consciously, though with equal, if not greater, intensity, they seek to assess each others’ class status through reference to signs of good health and ill health. The Article examines the centrality of that process to the nation’s hesitancy about providing universal health care. Recent responses to the reproductive health needs of poor women are illustrative. The passage of the Act reshaped and reinforced a narrative about poor women and their reproductive lives. The Article examines that narrative in detail in connection with recent federal and state resistance to funding abortions and family planning services. Within the politics surrounding health care reform, poor women with reproductive capacity have been marked as the “Other” within. In theory, they are beneficiaries of health care reform. In fact, deprived of the services they actually need, they are unlikely to flourish and are thus unlikely to become competitors on the nation’s socioeconomic ladder. The harm to them is clear. The harm to the nation is harder to discern but equally real. It includes less good health, larger social problems, and less contentment for everyone