"Mama Might Be Better Off Dead" is an unsettling, profound look at the human face of health care. Both disturbing and illuminating, it immerses readers in the lives of four generations of a poor, African-American family beset with the devastating illnesses that are all too common in America's inner-cities.
The story takes place in North Lawndale, a neighborhood that lies in the shadows of Chicago's Loop. Although surrounded by some of the city's finest medical facilities, North Lawndale is one of the sickest, most medically underserved communities in the country. Headed by Jackie Banes, who oversees the care of a diabetic grandmother, a husband on kidney dialysis, an ailing father, and three children, the Banes family contends with countless medical crises. From visits to emergency rooms and dialysis units, to trials with home care, to struggles for Medicaid eligibility, Abraham chronicles their access (or lack of access) to medical care.
Told sympathetically but without sentimentality, their story reveals an inadequate health care system that is further undermined by the direct and indirect effects of poverty. When people are poor, they become sick easily. When people are sick, their families quickly become poorer.
Embedded in the family narrative is a lucid analysis of the gaps, inconsistencies, and inequalities the poor face when they seek health care. This book reveals what health care policies crafted in Washington, D. C. or state capitals look like when they hit the street. It shows how Medicaid and Medicare work and don't work, the Catch-22s of hospital financing in the inner city, the racial politics of organ transplants, the failure of childhood immunization programs, the vexed issues of individual responsibility and institutional paternalism. One observer puts it this way: "Show me the poor woman who finds a way to get everything she's entitled to in the system, and I'll show you a woman who could run General Motors."
Abraham deftly weaves these themes together to make a persuasive case for health care reform while unflinchingly presenting the complexities that will make true reform as difficult as it is necessary. "Mama Might Be Better Off Dead" is a book with the power to change the way health care is understood in America. For those seeking to learn what our current system of health care promises and what it delivers, it offers a place for the debate to begin.
Cool yet compassionate eyewitness report of an inner-city black family's struggle to cope with sickness and poverty. Abraham, expanding on articles she wrote for The Chicago Reporter, demonstrates brilliantly just how confusing and cumbersome our national healthcare system has become. From May 1989 to April 1990, Abraham followed the (pseudonymous) Banes family as its head, Jackie, cared for her bedridden diabetic grandmother; her alcoholic, partially paralyzed father; her drug-abusing husband, on thrice-weekly dialysis following kidney failure; and three young children. The labyrinthine mysteries of Medicare and Medicaid are daunting even to the Yale-educated author, yet Jackie must make what sense of them she can in order to keep her family going. Still, services that might have protected the children's health or lightened the family's burdens often aren't taken advantage of thanks to confusion about how the system works, lack of information, and the overwhelming job of simply surviving from one clay to the next. Abraham concentrates on two stories - that of Jackie's grandmother, whose condition worsens, requiring hospitalization, then nursing-home care; and that of Jackie's husband, who receives a second kidney transplant. Both stories raise the issue of rationing: Could the $120,000 spent on the final months of the grandmother's life have been better utilized? How should recipients be selected for scarce organs? Abraham's depiction of the Baneses' plight reveals serious flaws in our health-care system, but the more basic problem is seen to be the devastating social illness of our inner cities, an illness no national health plan can cure. Abraham doesn't pretend to have the answers - but she illuminates the problems with passion and skill. (Kirkus Reviews)