It's a metaphor for the greater issues of being poor, which, as you quite accurately stated, are health care, education, and rent. Health care: you can afford

It's a metaphor for the greater issues of being poor, which, as you quite accurately stated, are health care, education, and rent. Health care: you can afford your insulin or you blood sugar goes out of whack and you end up in the ER. Education: you can't afford the time to learn a new skill (or even attend school) so you can't move up out of your low-paying job. Rent: you're paying high rent instead of owning. The issues extend from these all the way down to the boots level.