My partner has been sick for the last few days. Yesterday, he went to pick up a covid test from CVS. They told him that without insurance, the test would cost $200.

Luckily, it wasn’t the end of the world: he was able to use a spare test that his friend happened to have, and based on his symptoms, it was pretty unlikely that he’d had covid in the first place. But what if he’d been coughing? Or had a fever? Or experienced shortness of breath? A covid test is only the first of a series of concerns, not least of which is the extreme price of hospital stays, especially if you don’t have insurance. This unaffordability of basic resources like covid tests came as a shock to me, as it differs drastically from Biden’s rhetoric about working-class people and covid — that being: “We need to make them care about this! We need to teach them how to be responsible and healthy!” The ignorant focus on promoting personal responsibility, instead of alleviating structural concerns like unaffordability, is disturbing but not surprising. And the covid test is only a very, very small part of the difficulties working-class people face in accessing affordable body knowledge.

I see my primary care physician at a huge center in Baltimore City that specializes in LGBT healthcare. It is one of the few places in the area with a couple of doctors who are experienced in trans healthcare (i.e., a basic understanding of hormones and how to use respectful language — the bar is low). This center provides a wide range of medical and mental health services, and offers a lot of free and reduced-cost options, including sliding scales for those who don’t have insurance. Because of this, it’s a really useful resource for a lot of people in the area, LGBT or otherwise. Unfortunately, and unsurprisingly, it’s also underfunded. There are far, far more patients than doctors; their phone systems are a nightmare to navigate; and wait times for appointments are usually upwards of 3-4 weeks, even for urgent concerns.

I was recently reminded of this because I experienced several health issues within a short period of time. I avoid the doctor as much as possible, but eventually needed to see my GP. I could stomach the long wait time, although it made me nervous to have to ignore a potentially serious issue for 2 weeks before I could see my doctor (she double-booked me so I could get in sooner). I saw my provider and was rushed through the appointment because she sees so many patients that appointments can only be 20 minutes long. I wasn’t satisfied with her feedback; I felt like I wasn’t given the time or careful attention I needed for my concerns. So I decided to see a specialist. I got some answers and felt like I could trust his feedback more since it came from an expert in my particular issue, provided during a thorough 45-minute appointment specifically dedicated to that concern.

The thing is, that opportunity is a privilege. The ability to choose — to find someone who could provide the knowledge I wanted — was only available to me because I have good health insurance provided by my mom’s stable middle-class job. My partner doesn’t have the luxury of getting a second opinion unless he wants to pay hundreds of dollars for an appointment. Working-class people, and all those without health insurance, do not have the luxury of choosing between an affordable, crowded, understaffed office and a small office with a specialist who can spend up to an hour on a patient. Therefore, the knowledge these folks can access about their bodies is limited.

These thoughts also come on the heels of a decision I’ve been trying to make for months: whether to see a specialist (likely a series of them) to seek a formal diagnosis for a genetic condition I have called Ehlers-Danlos Syndrome. It causes a variety of physical traits like stretchy, elastic skin, as well as more serious effects like chronic pain due to joint slippage and frequent dislocations. Some people characterize it as a disability due to the impairment it causes, and most of us are more familiar than we’d like to be with braces, splints, and mobility aids.

It would be a pain in the ass to try to convince doctors to diagnose me, since it’s a pretty rare condition and there really isn’t any sort of test for the most common form of the condition. I’d be trying to get a doctor to put a name on the experiences I already know I’m having. And there isn’t really a treatment. The diagnosis wouldn’t give me much more than some formal paperwork confirming what I already know. But that diagnosis — the confirmation from a medical doctor that I do feel the way I say I feel, for a valid reason — is valuable knowledge. In our society, medical doctors lend legitimacy to our claims about our bodies. Paperwork establishing this knowledge can be used to file for things like accommodations through Student Disability Services. And interpersonally, we often don’t take diagnoses seriously unless they come from a doctor. Trust in our own bodies, the way we’re feeling, and its connection to diagnosable conditions, are legitimized through medical diagnoses and paperwork.

All this to say: knowledge matters. Seeking knowledge through the healthcare system helps us understand our own bodies, legitimize what we know to be true, and receive documentation we can use to prove that our body knowledge is backed by medical science. In the case of the covid test, body knowledge helps us protect others by knowing when we need to quarantine. But this knowledge is cordoned off, to be accessed only by those who can afford health insurance. The state holds monopoly over knowledge, and dispenses it out to the middle and upper classes through access to insurance, resources, capital, universities, degrees, et cetera. The healthcare system is but one of many arms of a classist, capitalist state.