In Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth, Sarah Smarsh describes how Reagan-era policies pushed her family from working class to working poor, mapping their increasingly impoverished lives against the demise of the family farm, the defunding of public schools, and—as she explores in this adapted excerpt—the dismantling of public health care.
My childhood in Kansas happened to coincide with the moment that health-insurance and drug companies essentially merged with the nation’s for-profit hospital system, creating costs that were prohibitive for uninsured families like ours.
In our parts, health care was rare not just because of escalating costs but because of our remote location. We didn’t put much faith in doctor visits, anyway. We told ourselves that we didn’t need doctors, but the truth was that we couldn’t afford them. If you had a real health emergency, you were liable to be dead before some small town’s ambulance made it down the muddy, sandy ruts of our dirt roads. But a decade-old dropper of stinging red iodine would fix most cuts, so we went on like everything was fine.
By the time I was born, rural hospitals were closing and American health care had been transformed into a slick big business in the urban centers. Being the youngest of six, my dad was the only baby that Grandma Teresa gave birth to in a hospital rather than in the farmhouse where they were raised. But when I was a kid, the old ways of country doctors were still hanging on in places like ours—places that, I would later learn, much of the country thought endured only in movies and books.
As an infant, one night I came down with a dangerously high fever. My parents rushed me miles along bumpy roads to the rural home of Dr. Joseph Stech, a small-town physician who still sometimes made house calls. Dr. Stech had delivered me at a big Wichita hospital, but as I grew up he was still charging a modest fee for a visit at his 19th-century office on Main Street in nearby Andale. He gave me all my immunization shots and prescribed penicillin when I got strep throat.
We didn’t have health insurance, but my parents could afford Dr. Stech’s fees. When I came down with chicken pox the day before the Christmas play at school, I cried next to our kitchen telephone while he told Mom over our shared rural party line that I had to stay home.
Once in a while, we’d drive past what to my eyes was a grand mansion on a hill, and my parents would say, “That’s where we took you when you were a baby and had a fever in the middle of the night.” No one remembered what Dr. Stech did to save me. For my family, the more important takeaway was that I just wasn’t meant to die that night.