Donald Trump, UnitedHealthcare, and the “Villains” of a Broken Economy

Most book dedications are forgettable. But Sarah Jones has written one that isn’t simply memorable, but is a ringing statement about the importance of memory: “For the dead, and everyone they left behind.”

The New York magazine writer first channeled a “howl of outrage,” she tells me, into an essay in late 2020, about the loss of her grandfather to COVID-19 and how the health care system failed him. She then spent four years broadening her personal pain into a wide-ranging exploration of the pernicious economic and political forces that left millions of Americans so vulnerable to the pandemic.

The result is her new book, Disposable: America’s Contempt for the Underclass, which mixes wrenching profiles—like that of Terence and Ebony James, public school teachers in Fresno, Texas, who find themselves hospitalized with COVID at the same time (one survives, the other does not)—with a searing case for how capitalism’s prioritization of profit drives systemic inequality and dehumanizes the poor.

Jones’s book arrives at the perfect time, in a perverse sense: Donald Trump campaigned, yet again, on standing up for the working class. But now, as president, he’s pushing to slash vital domestic safety net programs like Medicaid and to deplete Social Security’s trust funds, while cutting taxes for the wealthy. “Trump is a triumph for the ruling class,” Jones tells Vanity Fair. “So I really take issue with the notion that this is Trump’s country. If you’re a person who wants to oppose what he’s trying to do, you can’t afford to think that way.”

Vanity Fair: Your book is hard to read. And I mean that as a compliment. Because you depict a series of hardworking, compelling Americans, many of whom end up dying from COVID-19. It’s one gut punch after another for the reader. Was reporting and writing this book hard on you emotionally?

Sarah Jones: It was and it wasn’t. One of the big catalysts for writing the book was the death of my grandfather from COVID, so that was always kind of hanging over this project. So, “cathartic,” I don’t think that’s quite the right word, but to have that in common with so many of the people who spoke to me about their loved ones, it was kind of a relief to share our stories. At the same time, it was difficult because I was just thinking about death all the time.

Your grandfather cycled in and out of emergency rooms and subpar nursing homes, in part because of insurance coverage issues with UnitedHealthcare, a company you describe as “one more predator competing for his time and money.” Three months after you finished writing, Luigi Mangione allegedly shot and killed the CEO of UHC. When you heard the news, did you feel prescient, queasy, or something else?

I think “queasy” is a good way of putting it. I felt like there was a sense of inevitability about the whole thing. And I don’t say that to justify what [Mangione allegedly] did by any means. I just mean the health care system is so dysfunctional, and so many people are suffering as a result of that dysfunctionality. You combine that with the prevalence of guns and violence in America, and it just seemed like eventually someone was going to take matters into their own hands. And unfortunately, that seems to be what happened in the case of Luigi Mangione. It was shocking, but it wasn’t hugely surprising. I thought back to conversations I’d had with my husband, with friends, and really anyone who was familiar with my own family’s health care struggles or who might be having struggles of their own, years ago—that it’s kind of amazing no one’s done this to a health care CEO yet.

One goal of the book seems to be to portray COVID victims as real people and not simply statistics. Your grandfather, Charles Tibbetts, died in September 2020, at the age of 86, after leading a difficult blue-collar life.

He came from poverty and worked hard until he couldn’t, which is such a common American story. His health had begun to decline a little bit before the pandemic. But we were hopeful that he was going to be able to enjoy his final years. Of course, that is not what happened, and so when he died, I was just struck by the injustice of it, the fact that somebody could work hard their entire life and be made more vulnerable by that, in a sense. We spent the final few months of his life really in isolation from each other, and we couldn’t make up for the years we’d missed. And that was a pretty common story as I discovered when I was working on the book.

The individual stories you tell are vivid. How did you try to put them into a larger political and economic context?

I’ve written a lot about labor and working-class issues as a journalist and so I understood my grandfather as not being a unique case, but as belonging to a class. And I wanted to explore what COVID was doing to members of that class.

The sort of political economy that we have in the United States did bear responsibility in his death and did bear responsibility for many of the deaths that I talk about in the book. COVID has really removed a veil that may have hung over the American economy for a lot of people and made it harder to deny that we do treat people, many people, as being disposable.

Watching [Trump’s] inauguration, I was really struck by the presence of tech billionaires in such a prominent place, and the fact that we have a political economy set up where they can passively accrue that much wealth. And it’s really obscene and grotesque to me. There are so many villains and so many political failures that go into making that a reality. I lay a lot of the blame on the political parties. They’re not equally bad actors by any means, but I would argue they are both really committed to this political economy and to capitalism in a way that makes it hard for either of them to really challenge it.

One turning point you identify in the lead-up to the pandemic is the enacting of a 2015 California law that removed most nonmedical vaccine exemptions for school children, because it brought together the anti-vaccine and right-wing movements.

You could really see this coalition came together in a way that now is undeniable that it exists. You could see conservatives come out and express these really strong anti-vaccine sentiments. Lawmakers were harassed and threatened for their involvement. It was the polarization that now has really become a dominant force in American politics.

Is that California example part of a larger point you’re making about the public sphere—whether it’s public health or public education—becoming a particular target of the right?

The right-wing benefits when society is atomized and we’re kind of isolated from each other and working against each other. They benefit when we’re fearful and we don’t understand each other, and we are less likely to develop a sense of solidarity.

In the book, you quote Studs Terkel and Friedrich Engels chronicling the plight of the underclass. Which made me think: Maybe the particulars of COVID were new, but isn’t this really just the eternal story of power? Wasn’t it ever thus?

I think it’s been the story of power, certainly, or the way that power is currently distributed. But I believe it doesn’t have to remain that way. There has been progress, right? The situation that Engels described is not necessarily the situation we have now in every respect, even if I think the basic power structures are the same and the basic ability of certain classes still exists. I don’t really believe that there are intractable problems. I believe that we just have to think a little more radically about who’s in power and how power is distributed and how it’s applied, especially in the wake of the pandemic.

I think back to the New Deal. I think back to the civil rights movement. And it always takes such an enormous effort. And people have even lost their lives in this struggle to make America a better place. But you do have these moments where there is progress.

There’s a great deal of justifiable anger and darkness in the book, but also glimpses of people doing heroic work, such as the Boston Health Care for the Homeless Program.

I found their story really powerful—not just because what they did worked really well and saved many lives, but I think it’s a model. Not to put this in sweeping generalities, but it made me more optimistic that the sort of world I would like to see is possible when we pool our resources and prioritize the needs of people who have been treated as though they’re disposable for so many years.

One question you ask about the pandemic and its cruel toll on the middle and lower classes is: “Why wasn’t everyone as furious as I knew myself to be?” Did you find an answer?

There is no tidy answer. People are processing the same reality in a different way. Maybe that doesn’t mean they’re not angry. Maybe they’re grieving. Or maybe that anger shows up in a vote for Donald Trump. It’s not showing up in a way that, as someone on the left, I wish it would. Like, no one’s marching in the street right now for single-payer health care.

To your credit, in my view, you resisted any urge to end the book with an uplifting five-bullet-point program. But there are recurring themes and ideas you clearly believe could reduce inequity.

I do think we can achieve single-payer health care. I think it’s going to be a big fight, but I think it’s possible.

As somebody who has struggled financially and, as I discuss in the book, has even struggled with my mental health at points, what really made a difference in my life was having reliable housing. So rent control and building more housing, I think, would go a long way to providing stability to a lot of people.

I’m very active in our union at New York magazine. From that perspective, both personal and professional, I do believe unionization is the answer to a lot of problems. Yet the labor movement is under such attack right now, as it has always been.

One book can only accomplish so much, and you can only fit so much into it, but I wanted to use human stories to make an argument in favor of memorialization. And to me, memorialization isn’t just about a statue somewhere or a holiday, a day off from work. It’s about, if we’re truly going to honor the dead and reckon with what happened during the pandemic, then we need different policies. We need a different political economy in this country. So it’s an active, living process rather than just, we’re going to wear yellow for a day.