The New York Times hits the right note, almost in passing, in today’s article on the difficulties working-class women face in breastfeeding due to opposition from employers. Women are more and more pressured to breastfeed (witness the Times’s own notorious article - titled “Breast-Feed or Else” - virtually accusing them of child abuse if they do not), but those with fewest choices economically have the hardest time doing so, especially because employers, while sometimes paying lip service to woman-friendly policies, prohibit women from doing what is necessary to keep their kids in best health.

When a new mother returns to Starbucks’ corporate headquarters in Seattle after maternity leave, she learns what is behind the doors mysteriously marked “Lactation Room.”

Whenever she likes, she can slip away from her desk and behind those doors, sit in a plush recliner and behind curtains, and leaf through InStyle magazine as she holds a company-supplied pump to her chest, depositing her breast milk in bottles to be toted home later.

But if the mothers who staff the chain’s counters want to do the same, they must barricade themselves in small restrooms intended for customers, counting the minutes left in their breaks. . . .

[A]s pressure to breast-feed increases, a two-class system is emerging for working mothers. For those with autonomy in their jobs — generally, well-paid professionals — breast-feeding, and the pumping it requires, is a matter of choice. . . . But for lower-income mothers — including many who work in restaurants, factories, call centers and the military — pumping at work is close to impossible, causing many women to decline to breast-feed at all, and others to quit after a short time.

It is a particularly literal case of how well-being tends to beget further well-being, and disadvantage tends to create disadvantage — passed down in a mother’s milk, or lack thereof.

Breastfeeding is a health issue for newborns, and promoting and supporting breastfeeding - or erecting barriers to it, as we do - has real public-health consequences. It is such a no-brainer, in fact, that one federal legislator who does support it can’t seem to understand why the government hasn’t gotten on the bandwagon, raising the question what planet she thinks she’s on:

[F]ederal law offers no protection to mothers who express milk on the job — despite the efforts of Representative Carolyn B. Maloney, Democrat of New York, who has introduced such legislation. “I can’t understand why this doesn’t move,” she said. “This is pro-family, pro-health, pro-economy.”

It’s also pro-woman, and it involves breasts. Two stakes through the heart in a country where “feminism” is actually a term of slander, and that nearly had a collective heart attack - and imposed a $500,000 fine on the broadcasting company - after seeing just part of Janet Jackson’s right nipple on TV for two seconds.

But this issue is merely an emblem of the underlying problem - a problem so pervasive and so much a part of our country’s economic and healthcare system that I’m actually surprised a reporter noticed it, or was allowed to mention it in print. We have chosen a free-market healthcare system - or, more accurately, we have had a free market healthcare system imposed on us by those who run the healthcare market - in a free-market economy so wedded to laissez-faire that workers have no guarantee of health benefits of any kind, the federal minimum wage is almost 15% below the official federal definition of poverty for a single parent with just one child, and the Republican administration is actively working to dismantle the national retirement-benefit program.

The reporter (Jodi Kantor) had it just right when she noted “how well-being tends to beget further well-being, and disadvantage tends to create disadvantage” - though she seemed to be going out of her way to avoid the more obvious expression of the same idea: the rich get richer and the poor get poorer. (She did sneak the word “class” in there, ambiguously, which may have been the most she could do.)

In a cutthroat economy in which worker welfare is a dead letter, the best one can hope for is to grab all the goodies one can for oneself. (Those female execs at Starbucks, langorously pumping away at their swelling, fertile mammaries while reading fashion magazines in lounge chairs, obviously haven’t had much success at pushing lactation policies down to the worker level, and one is entitled to wonder how hard they’ve tried, or how much it bothers them that the female drudges below them have to squat in bathrooms on a timeclock, in fear of being fired for trying to feed their own children.) And in an economy where health, working conditions, and, indeed, feeding one’s children are just perks to be negotiated between worker and employer (on an equal footing of course), staying alive and healthy are just some of the goodies one hopes for but cannot count on. As with other perks of employment - vacations, travel expenses, company cars - not only are better rewards offered to those who are already getting better rewards of other kinds, but being at the level at which a reasonable security of a decent life is available makes it vastly easier to keep on keeping on up the ladder of success.

There’s a kind of threshold one crosses between abject poverty and just-getting-by (usually the threshold of having a full-time job), another between getting by and comfort (usually the kinds of jobs that come with seniority in a union, or with a college education), another between comfort and affluence (owning the company, or having a job that lets you determine whether other people get to cross the thresholds below you), and between affluence and true wealth (living on investment income, not a salary).* Crossing each such threshold not only materially improves your life circumstances, it makes it much less probable that you will later slide back below that threshold if things change. At each level there are higher and lower degrees of success, but people tend to move within levels (recall the many shocked magazine articles after the dot-com bust, profiling poor ex-yuppies who actually had to take non-managerial jobs after their product-less Internet companies went bankrupt; the fact that it was unthinkable is testimony to how real, and how treasured, the threshold effect is).

The result of treating healthcare as a job perk is that we now impose thresholds on health benefits, and health itself. The breastfeeding case is illustrative: for women below the lower economic thresholds (or, just women with jobs that force you to stay on your feet, as opposed to working in an office with secluded break rooms or women’s lounges), work conditions and employer pressure make it a practical impossibility to pump breast milk during the day; as a result, they stop lactating too soon to keep their children on a steady breast milk diet. Their kids are literally shut off at the source from a significant health benefit due to their mothers’ employment circumstances. The children of women with better working conditions - in which milk banking becomes a de facto job perk simply because it’s possible - get better health in the same way that the children of the rich get better educations and admission to fancy schools. These benefits multiply over time - you could say that breast milk is a kind of free-market Head Start program for the children of upper-class women and those lucky enough to work in offices populated by upper-class women.

Health accrues as a perk in other ways, direct and indirect. The indirect ones are too many to name, and are well-known anyway: safer and more healthy neighborhoods, easier access to outdoor play facilities, less pollution and fewer toxics or vermin in the house, and so on. The most direct health perk - access to healthcare itself by way of insurance - is also obvious. But there are others. Health insurance matters a great deal, but what kind of insurance one has matters also: the majority of the 40% “underinsured” Americans actually do have so-called health insurance, but it does not pay for many important needs; it is commonplace, however, for firms to offer “executive” health plans that provide vast ranges of services the proles never even hear about, taking “health as a job perk” to a literal extreme. (And an absurd extreme at that. “Executive physicals” - ridiculously intensive test-heavy health workups that costs $5,000 or more and can take several days are a popular perk, though they offer almost nothing by way of better health.) Rural areas and suburbs have fewer and less-advanced healthcare facilities available to them. Limits on vacation and sick time, or on the use of days off to care for sick children, may mean that health benefits are effectively unusable in important cases even if they are nominally available. The fear of privacy invasions by their employer prevents employees from using their health benefits even when they could do so. The dread “pre-existing condition” exemption from health coverage can have the same effect, particularly in an unstable work world where any worker may have to face unemployment or changing jobs without notice. (I personally know several people who have stayed at jobs they hate, sometimes in cities they hate, for years or decades because of their inability to get healthcare from another source. I know some who have been separated for years but cannot divorce because one spouse or the other has chronic health needs and must get care through the other’s insurance. The lack of care is not just making people sick, it’s ruining the rest of their lives as well.) Health club memberships, vacation time, personal-time flexibility, regular hours - all these are job perks that have a decisive influence on health.

And, in another example of the “rich-get-richer” phenomenon, health and sickness themselves tend to be self-reinforcing. Those who enjoy good health in a good environment get sick less and recover faster. Those who have poor health are susceptible to other health problems that compound over time. Poor health begets poor job prospects, which ruin one’s health . . . and so on. (Sinclair’s The Jungle wrenchingly illustrates this pattern, and the way workers are pitted against each other to maintain that system.)

The point to all this is that health issues are structural - largely economic - problems in addition to being biological, scientific-medical, nutritional, or environmental problems. Indeed, the economic system in which we treat health and healthcare largely creates the scientific, environmental, nutritional, and other such conditions, making them structural problems as well. And that structure - laissez-faire and job-based - throws health in among the other rewards of the market system. It treats biological health as something one can earn by effort or luck in the marketplace, not as a minimum parameter defining employers’ obligations regarding working conditions. (It thus treats workers’ bodies - and those of their children and dependents - as part of the capital they bring to the bargaining table in the job market.) It is a system that, literally and explicitly, treats the mother’s milk of lower-class children as a waste product to be flushed down the toilet in order to keep women at their work stations according to their employers’ schedules.

“I feel like I had to choose between feeding my baby the best food and earning a living,” said Jennifer Munoz, a former cashier at Resorts Atlantic City Casino who said she faced obstacles that included irregular breaks and a refrigerator behind a locked door. She said she often dumped her milk into the toilet, knowing that if she did not pump every few hours, her milk supply would soon dwindle.

We obviously can run a country this way - we are doing so. I can’t imagine why any decent person would want to.

* NB: I don’t mean these milestones as the definitions of any of those economic categories. In particular, lots of people, especially retirees, live on investment income but are not wealthy, lots of jobs that nominally require a college education pay shitty wages, and the minimum full-time wage, as I’ve pointed out, is still at poverty level. The point is merely that these are the lines you typically cross in moving from one category to another.