If this matters…
Comment.
Send a letter you'd like me to post. Like the Hickory Hound on my
various platforms. Subscribe. Share it on your personal platforms. Share
your ideas with me. Tell me where you think I am wrong. If you'd like
to comment, but don't want your comments publicized, then they won't be.
I am here to engage you.
Get in touch: hickoryhoundfeedback@gmail.com
-----------------
๐คThis Week:
Monday - (Substack) - The Foothills Corridor - Chapter 24: Reclaiming Control from Charlotte and Raleigh - For
decades, the narrative—and the capital—have flowed east and south.
Charlotte and Raleigh have dominated political agendas, media attention,
and economic development pipelines. The Foothills Corridor has often
been treated as an afterthought: too rural to prioritize, too fragmented
to organize, too slow to invest in.
Tuesday - ๐⭐Toward a Healthier Hickory: A Community Investment Perspective⭐️๐ - "This
Feature Report examines the health and cultural landscape of Hickory
and Catawba County. It builds on earlier News and Views segments to ask:
how strong is our community’s foundation of well-being, and what must
be done to secure it for the future?"
Thursday - ๐งฑ Factions of Self-Preservation 8 (Summary Conclusion): Walls Within - How Hickory Built Defenses Instead of
Solutions - Hickory isn’t declining from a single crisis. It’s retreating in slow
motion—system by system, choice by choice.
Friday - (Substack) - Chapter 25: The Future Isn’t a Revival—It’s a Reinvention -For
all the talk of comebacks and revivals, here’s the truth: the Foothills
Corridor is not going back to what it was. The furniture mills aren’t
reopening. The textile plants aren’t restaffing. The industrial rhythms
of the past century have ended.
-----------------
๐คNext Week:
Monday - (Substack) - The Foothills Corridor - Conclusion: A Blueprint for Rural Reinvention - The Foothills Corridor has been many things—an industrial engine, a forgotten backwater, a place people left behind, and a place people still refuse to leave. What’s emerged through this journey is not a return-to-glory fantasy or a feel-good economic report. It’s something harder, truer, and more necessary:
Tuesday - Dear Rachel - Episode 9: Building Amid Collapse - Episode 9 of Dear Rachel dives into the fading backbone of local economies: the people who still build amid decline.
Thursday - ⚙️Structural Schisms 1: The Vanishing Middle - Structural Schisms is a series about how Hickory’s systems function
— not just the people who work within them, but the design, duplication, and
disconnects that shape local results. Hickory’s
middle-income stability has eroded over twenty-five years as the cost of
ordinary living rose faster than household earnings.
๐ง Opening Reflection
So far in October we measured the non-negotiables—roof, table, and lights. Healthcare is the fourth pillar. It doesn’t charge you monthly in neat numbers until it does—through premiums, deductibles, denied claims, time off work, and the quiet costs of delayed care. This piece turns the HCI lens onto health: who is covered, who is cared for, and who is quietly opting out.
Health has never been free and the financial side of the industry has never made sense. The politicians will never say anything negative about the insurance, pharmaceutical, or medical companies, because they have played a major role in sanctioning this swamp. In my life, I have seen that it is best to keep all of this contraption at arm’s length when you can, but at some point in time you will have to utilize these services. That is reality.
My experience has always been that going to the doctor is inconvenient, but it is also a necessity, especially as one gets older. In Hickory today, the financial side of the equation keeps many people from getting proper medical attention. For those who fully participate in today’s American healthcare system, the cost of staying well has become a form of rent—obligatory, monthly, and increasingly eating into one’s ability to maintain a budget or save money for a future rainy day.
Over this month, we have traced the everyday economy that defines survival: shelter, food, electricity, and now the body. Each represents an element we need to maintain personal stability. Though they differ in form, the four costs obey the same rule of necessity. Housing and electricity are tangible and largely inelastic—one must pay to remain sheltered and lit. Food sits midway: its calories can bend to the budget, though nutrition suffers when money runs short. Health is the least predictable.
With regard to health, insurance premiums are the same for the year, but illness risk is intangible and its expense arrives without schedule. Financially vulnerable people will often delay visiting the doctor. This choice is often the only control a person or family retains. Those delays often lead to worse outcomes. Together they form the modern arithmetic of survival, where tangible needs can be measured in bills and intangible ones in fear.
The costs of shelter, food, and electricity are ones you have more control over. Living arrangements, what one eats, and heating and cooling choices all afford compromises. You can downsize where you live, have roommates, or move to a less expensive area. You can eat less quantity, less-expensive cuts of meat, and not eat out. With regard to electricity, you can wear more layers in the winter, run fans in the summer, and guard against wasteful appliance use. People further up the socioeconomic ladder find that adjustments can save hundreds of dollars a month.
The compromises one makes with regard to health carry heavier risks. Each year, insurance costs for the same plan have outpaced inflation and the cost of living. Not only is there the monthly premium to pay, but there are copays and coinsurance, and other gaps created as cost compromises for affordability. Then there are issues if one misses significant time from work. If a worker is laid off, health insurance often goes with the job. You still have options like COBRA, but it is cost prohibitive, so if you do not have a cushion to fall on then the risk is severe, especially if one is responsible for others.
In Catawba County, about one in three adults now report delaying medical care because of cost. For many, the calculation is simple: the deductible exceeds what is left after groceries and utilities. The ALICE report sets a family’s monthly health line near $735, a figure that assumes no emergencies, no dental work, no hospitalization. For those living in the tenuous middle class and strained bottom 40%, that number might as well be theoretical. The reality is improvisation—self-treatment, skipped refills, delayed tests—and the quiet gamble that the body will hold out another month.
I have come to believe that this is where economic strain becomes personal truth. You can ration the air conditioning, stretch the meals, or drive less to conserve fuel. You cannot postpone illness indefinitely. What we are witnessing is the human cost of deferred maintenance—not the public kind on roads or power lines, but the personal kind on ourselves and our families. Every dollar that households save by not seeking care reappears somewhere else—in chronic pain, lost productivity, or the worry that shadows an aging parent or a child’s fever.
This week’s feature continues the October ledger, following the cost of comfort, the cost of home, the cost of the table, and the cost of keeping the lights on. It asks what happens when the last form of personal capital—health—begins to erode. Because when a community can no longer afford to help its people heal, the problem is no longer medical; it is structural.
⭐ Feature Story ⭐
Health is the quietest line in the household budget, but it can determine everything else. In Catawba County, the survival budget for a family of four allocates about $735 per month to healthcare, roughly thirteen percent of total living costs. That figure excludes dental work, prescription inflation, and emergency care. Beneath the averages lies a familiar divide drawn sharply in the Cost of Comfort Index.
For the comfortable top-fifth of households, health spending remains predictable. Employer coverage absorbs shocks; deductibles are high but manageable. A child’s broken arm or a round of therapy becomes an inconvenience rather than a crisis. These families still budget for wellness, not recovery.
The tenuous middle class, representing the broad center of Hickory’s workforce, lives closer to the line. Premiums consume a week’s wage, and networks shrink each year. Families delay tests, refill prescriptions in half, or wait until a condition demands urgent care. Mental-health appointments disappear first, considered a luxury when rent and food already strain the paycheck. Stability is preserved through postponement.
The strained bottom forty percent faces a different reality. The Catawba County Health Assessment (CHA) of 2023 reports that fourteen percent of adults remain uninsured and thirty-one percent delay care. For these residents, the emergency room becomes the default clinic. Medical debt follows, reducing credit scores, complicating housing, and perpetuating the cycle of insecurity. In these homes, health spending is not a budget line; it is a gamble.
Local wages amplify the burden. The current median household income is approximately $65,000 in 2025, well below the national figure, and more than half of county jobs pay under $20 an hour. Health premiums rise faster than paychecks, and copays creep upward. Each year the threshold between the tenuous middle class and the strained bottom forty percent widens. What once distinguished the working class from poverty is now the ability to afford a check-up.
Across the Index categories, the pattern repeats: as comfort declines, elasticity collapses. Elasticity, in this case, is the ability to absorb personal economic shocks. Housing and power costs rise with markets and regulation; food prices follow supply; health costs surge through complexity. Of the four, only food offers substitution; the others are fixed or unpredictable. That difference defines class vulnerability. The middle trims its basket; the bottom postpones the clinic. When income falters, every necessity becomes immovable.
The state mirrors this pattern. North Carolina’s expanded Medicaid coverage closed part of the gap, yet rural provider shortages persist. The CHA notes a primary-care ratio of one provider to 2,400 residents, a figure that turns scheduling into a form of triage. Meanwhile, national trends continue their climb: the Kaiser Family Foundation’s (KFF) 2024 Employer Health Benefits Survey set the average employer family premium above $25,000, a seven percent jump in one year.
These numbers describe not just costs but behaviors. Households are learning to live with chronic conditions as a budget category. Preventive care declines; emergency care rises. Every skipped appointment becomes a deferred expense with interest. The body, like infrastructure, wears down from neglect.
Catawba County’s public-health system, funded at roughly $70 per resident compared with the state average of $98, cannot absorb all that deferred need. Clinics and nonprofits fill gaps with charity care, but the pattern holds: local illness is subsidized by private sacrifice. Families carry the deficit through unpaid bills, credit cards and other loans taken to cover medical costs, and the erosion of long-term health.
The cost of food and home show how exposed one can become to economic shocks and the effects on personal income and wealth. Rising energy prices put a strain on the whole community, but the vulnerable can least afford such events. Health costs reveal something even more personal: that illness steals time — time to work, time to care for family, time to live well. When people can’t afford to stay healthy, they risk losing not just money but years of their lives.
To restore balance, health must be recognized as a structural investment. Hickory’s employers, hospitals, and civic boards can coordinate preventive programs—community clinics tied to workplaces, transparent pricing for essential care, local funding for mental-health support. But reform begins with recognition: that the health ledger is not personal failure but civic math. We pay for neglect in healthcare one way or another—in debt, in disability, or in the gradual dimming of personal and community potential.
My Own Time ฮฉ
I have spent most of my life around work that
wears the body down. In the kitchens and dining rooms where I earned my living,
the noise of the hood and the heat of the line are constant. You learn to
endure. You fight fatigue with pride. You really don’t even acknowledge it,
because that is weakness, and the best of us don’t accept failure. But pride
does not pay the doctor. The older I get, the clearer it becomes that the aches
and strains we once shrugged off were not free — they were deferred bills that
come due later.
When I write about health now, I am writing
about people I have known all my life: cooks, servers, nurses, mechanics,
teachers, factory workers, parents, the ones who have kept Hickory running. Many
of them have worked through pain or illness because a medical appointment was
too expensive or their schedule was too tight. They wait for the cough to fade,
for the back to loosen again. Sometimes it does. Sometimes it doesn't. And
when it doesn't, the descent is quiet — time off, fewer hours, more bills,
another round of decisions that trade the need for recovery for feeling of survival.
I have watched friends and family ration
medication and skip dental care, not from neglect but from arithmetic. A week
of lost pay can break a month’s budget. I have seen servers on edge about that
night’s tips or a cook worried about hours being cut back when business was
slow. What was once a community of industrious households is now a landscape of
endurance. The resilience that once built this town has turned into tolerance —
tolerance for strain, for uncertainty, for difficulties.
That is the lesson of this October: every cost
we have tracked — food, power, health — is connected. They move together like
gears. When one seizes, the rest grind harder. Health is simply where the
pressure shows last and hurts most. A community that can't afford to heal
can't prosper, and a person who can't find relief can't imagine a bright
future.
For those of us who have worked with our
hands, health was never an abstraction. It was the strength to finish a shift,
to contribute, and to do it again tomorrow. When that strength falters, personal
dignity is what is at stake. That is why this is not just about medical care;
it's about moral accounting — what kind of city are we building when the
people who keep it alive don’t have the means to keep themselves well.
Tonight, writing under the hum of a cool
autumn evening, I can feel the connected thread that runs through every one of
these News and Views stories this month: the fight for the center to stay
whole. This is the news. This is the event. This is the reality. It is the struggle
we’ve lived, and the fight this community will continue to wage. We will keep
marching forward like that consistent hum you hear in the background. We have
no choice. Next week I will close this ledger and total what we have found. ‘Til
then I bid you adieu.
