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Abstract
In one of his address to the American Medical Association, President Barack Obama stated, “Make no mistake: the cost of our healthcare is a threat to our economy. It is an escalating burden on our families and businesses. And it is unsustainable for the United States of America.” Following these lines, ‘Mama Might Be Better off Dead ‘, by Laurie Kay Abraham, presents a disconcerting and an insightful look into the American health care system. This book offers a very unsettling, at the same time enlightening, view of the status of urban Medicare facilities, through the example of a financially troubled African American family. This book further throws light on how the Medicaid programs have failed some Americans, mainly the economically backward people living in the urban areas. The purpose of the book is to vividly delineate, the complexities that are involved in the equal distribution of health care to all the citizens of the country. It supplies a gripping rendition of how federal medical policies operate in reality.
The primary audience targeted by the author is all people who are concerned with the health care system of the country. So essentially, it addresses the entire citizens of the United States including both the voters and the elected representatives. Every person who is a part of the democratic machinery should be aware of the problems in the national Medicare policies, to bring some meaningful changes in the system, and this book aims at doing just that. It in essence captures the desertion of the poor urban families by the Government health care machinery. The author clearly explains how the elements of the American dream life, justice and liberty are mere truisms for the poor families of the country.
In the book, the author does the task of an objective observer, in explaining the day to day plight of a poor urban family, whose members suffer from multiple health care problems. The reader is guided through a plethora of ailment issues faced by this family on a day to day basis. The book is an account of the life of Jackie Bannes (pseudonym) between the period of May 1989 and April 1990. The ‘Mama’ referred to in the title is her grandmother, Cora Jackson, who is a bedridden diabetic. Jackie also has to take care of her alcoholic father (Tommy Markham) who has a paralytic problem, a husband (Robert Bannes) with a kidney ailment who is into drugs and three little children. So, life is a whirlwind of one treatment followed by another.
The family is based out of North Lawndale, which is in Chicago. The point to note here is none of the family member is medically insured. As Tommy Markham observes in the book,
“You could be damn near dying, and the first thing they ask is ‘Do you have insurance’?” (Abraham, 1993)
The book also skillfully explains the predicament faced by the family in deciding on medical reimbursement over better living conditions. For if Mrs. Jackson reports an income, she would not be given reimbursement on her medical bill, and if the family relocates to a moderately improved neighborhood, then they have to pay more towards medical expenses as they would be disqualified from the health care programs. The book talks both about doctors who stayed back in the Mount Sinai hospitals because it needed them more than the high paying city hospitals, and also about doctors who do not even enquire about the past history of the patients before treating them and make use of the welfare system for making money.
As Abraham takes pain to point out, there is a subculture within the United States of America, whereby the suburban ethnical groups gets sicker more frequently, than the middle and upper class Whites. This is sometimes due to genetic reasons, but more due to the lack of access to decent health care. The book is strewn with examples, on how the Medicare policy reimburses expenses for acute ailments, but not for chronic problems affects the poor. For example, Jackie was not able to afford for the adult diapers needed for her bed ridden grandmother. and the Medicare does not pay for it. But the Medicare does provide for the cost of urinary catheter, which is known to cause bladder sepsis.
It is important to note that, the author also stresses on the fact that, some of the family members were negligent in taking personal responsibility for their health. Robert continues to use drugs and alcohol even though he has a kidney failure and Jackie on her part fails to make use of a free measles vaccination for her children. Thus she also throws light on how lack of proper education and ill habits are a characteristic of the urban poor. She also hints on subtle and sometime forthright racism that also exists in the system. She states,
“What has not changed is that race and class still determine the setting in which people get care, and, not surprisingly, separate is not equal.” (Abraham, 1993)
Being economically backward, Jackie tries to make use of the various Medicare and Medicaid Government programs. While even the author, Abraham, who has a Yale degree, could not understand the complicated methodologies of these systems, yet Jackie has to somehow come to terms with them for her family’s survival. She desperately battles on a day to day basis to make sense of the various labyrinthine procedures of the health care system, to keep her family afloat. But despite her efforts, services which presumably should have reduced her burden, did not come to her aid at the time she needed them most, mainly due to the daunting confusions of the system and lack of proper information to guide the common uneducated people.
Her story is an eye opener to all those who are involved in devising health care policies. It throws some important questions that are needed to be addressed on priority in the near future. How should the health care policies be simplified and how to ensure the clear education of the aids available to the urban poor under such policies? On what basis should the beneficiaries of organ transfer should be determined? Is the enormous amount of money ($120,000) which was spent on Mama’s health care during her final days justified? The author does not pretend to offer solutions to all the healthcare issues, but through the heartfelt depiction of the Banes family’s plight, she does throw some questions for us to ponder. As she tells at the introduction of the book
“Just as doctors use CAT –scans and other instruments to uncover disease, this book exposes glaring inequities in health care access and quality that exist between the moneyed and the poor” (Abraham, 1993)
Works cited:
- Andrew B. Bindman, & Miriam Komaromy. ( March 17, 1994). Medical Care and the Health of the Poor Mama Might Be Better Off Dead: The Failure of Health Care in Urban America. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJM199403173301126
- Laurie Kaye Abraham. (1993). Mama Might Be Better Off Dead: The Failure of Health Care in Urban America. Chicago, University of Chicago Press.
