Book Review: Mama Might Be Better Off Dead by L.K. Abraham

Introduction

This paper presents a critical review of Mama Might Be Better Off Dead: The Failure of Health Care in Urban America by Laurie Kaye Abraham. The critique covers the book's purpose, its scrutiny of various healthcare aspects as they relate to America's poor, and readers' reactions to the work. The focus of the book is on healthcare as of and up to 1994, its publication date. It does not take into consideration or discuss the healthcare changes introduced by the Affordable Care Act, also known as "Obamacare."

Topic, Purpose, and Audience

The book's main topic is the effectiveness of healthcare in the United States with regard to the poor as of 1994; it also addresses particular features of the American healthcare system. Many of these issues have since been addressed by the Affordable Care Act.

Abraham's Mama Might Be Better Off Dead offers a profound and unsettling view of the human dimensions of healthcare. A disturbing yet illuminating read, the book provides readers with a glimpse into the life of four generations of an African-American family living in poverty, plagued with the serious illnesses that have become commonplace in America's inner cities.

The book essentially addresses anyone who takes an interest in the healthcare issues of low-income American families. It would also be of value for those seeking to compare healthcare for the indigent before and after the implementation of the Affordable Care Act.

Summary of the Banks Family's Story

The book's story unfolds in North Lawndale, situated in the shadow of the Chicago Loop. Despite being surrounded by several of the city's best medical facilities, North Lawndale can be counted among the sickest and most underserved neighborhoods in America in terms of medical access. The Banks household, headed by Jackie Banks, struggles with numerous medical crises. Jackie must care for her diabetic grandmother, her ailing father, her husband who depends on kidney dialysis, and three children. From dialysis unit and emergency room visits to home-care challenges and the struggle for Medicaid eligibility, Abraham records the family's access — or, more precisely, their lack of access — to medical attention.

Narrated sympathetically yet without sentimentality, the story of the Banks family exposes an inefficient healthcare system further undermined by the direct and indirect effects of poverty. Poor people easily become sick, and sick people's families soon become even poorer. Abraham weaves these themes together to argue persuasively for healthcare reform, while at the same time unflinchingly displaying the complexities of achieving meaningful change. The book effectively opens a space to debate the current healthcare conditions for those seeking to understand the gap between the promises made by American healthcare authorities and what is actually delivered.

Critical Reaction to the Book

Two things become apparent upon setting out to review former Chicago journalist Laurie Kaye Abraham's Mama Might Be Better Off Dead: The Failure of Health Care in Urban America, which chronicles the battles of a destitute urban family in obtaining healthcare. First, Abraham did a remarkable job summarizing what this unusual book is about in her introduction, and she also addressed how her book differed from a conventional review. Second, even in her brief synopsis, Abraham — in explicit terms that surpass rhetorical and statistical abstractions — succeeded in explaining why health insurance coverage for the poor cannot be equated with actual healthcare support. She also explained why any healthcare reform that continues to ignore the fundamental needs of the country's poor will inevitably fail.

In her book, Abraham highlights that a long-ignored segment of America's population was not covered by any healthcare plan as of the date of writing. Problems for the indigent arise partly because years of bureaucratic neglect have made them weary and cynical of the struggle required to obtain decent medical attention, and partly because, despite their persistent efforts, they are too often denied care (Stabiner, 1993). Abraham spent a year living in North Lawndale, Illinois — a poverty-ridden Black community and a medical wasteland in Chicago where follow-up medical care was effectively a cruel joke, basic courtesy a costly luxury, and financial assistance a maze that encouraged divorce and unemployment. What is particularly alarming is that North Lawndale is just one among countless such neighborhoods across America.

Abraham's book recounts the life of African-American Jackie Banks and her family, and their efforts to maintain the family's health. Jackie's elderly grandmother, who raised her, has just had one leg amputated as a complication of uncontrolled diabetes that could have been better managed; her remaining foot has also begun to deteriorate. Jackie's father, who visits the family only when he needs help, suffered a stroke in his forties due to ignoring warnings about his dangerously high blood pressure (Stabiner, 1993). Jackie's husband, meanwhile, suffers from a progressive kidney disease that early diagnosis might have slowed. He must wake before dawn several times a week to visit a dialysis unit, as home dialysis is beyond the family's meager means.

During the year Abraham spent with the Banks family, she uncovered an extremely complex system that some patients simply give up on, becoming victims not only of disease but of state medical regulations as well. The national welfare system is riddled with Catch-22s: if Jackie's grandmother reports any earned income, she becomes liable for higher medical assistance costs; if the family income rises enough to allow them to move to a marginally better neighborhood, as Jackie hopes, a large portion of that income would have to go toward medical bills. Trapped before they can even begin to climb the income and lifestyle ladder, the Banks family has little choice but to remain where they are. The subtler and sadder issues, however, concern how they are treated once they do manage to see a doctor. Any observer sitting through a medical appointment where an internist takes a full patient history would be struck by the blunt indifference Abraham's subjects encounter (Stabiner, 1993). Physicians do not ask about prior medical problems, nor do they follow through on future treatment plans. There are a few luminous exceptions — doctors who could earn a comfortable living elsewhere but who recognize the urgent need for their presence in places like Mount Sinai's emergency room — but for each of these dedicated physicians, there are others of questionable competence who have learned to work America's welfare system to their personal advantage without committing to their patients.

Abraham's research is thorough and her understanding of the Banks family's circumstances is formidable. Her greatest strength — her attention to detail — is, however, also the book's one weakness (Stabiner, 1993). Abraham set herself a challenging task: a process-driven work, anchored in a narrative account of her time with the Banks family, that also summarizes national healthcare policy. The shift between storytelling and analysis does not always succeed. More often than necessary, she steps back to remind readers of the injustice of a healthcare system that is inadequate for the poor — that neglecting them perpetuates the very health problems they suffer.

Conclusion

Abraham argues that her account of a struggling household speaks directly to the threats faced by a growing number of American middle-class families as the ranks of the uninsured continue to swell. The point that comes through most powerfully, however, is a reality that most of mainstream America is unlikely to experience firsthand (Rochefort, 1994). In this light, the greatest danger to comprehensive healthcare reform lies in proposals that use modest insurance adjustments to ease the primary fears of the middle class while failing to address the fundamental question of social fairness that Abraham frames so eloquently. It can be said with confidence that the inequities and injustices described in this book likely had a meaningful influence on the Affordable Care Act. It is to be hoped that at least some of the issues Abraham so vividly documented have since been addressed.

References

Abraham, L. K. (1994). Mama might be better off dead: The failure of health care in urban America. University of Chicago Press.

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Mama might be better off dead: The human face of health care. (1993). Health PAC Bulletin, 23(4), 30–33. Retrieved April 26, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/10133594

Manning, & Grosso. (2011). Doctor of nursing practice students advocating for health care access, quality, and reform: From the virtual classroom to Capitol Hill (33). Retrieved April 27, 2015, from http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1032&context=nursfp

Medical care and the health of the poor: Mama might be better off dead: The failure of health care in urban America. (1994). The New England Journal of Medicine. Retrieved April 26, 2015, from http://www.nejm.org/doi/full/10.1056/NEJM199403173301126

Rochefort, D. (1994). Beneath the abstractions of our health care debate. Health Affairs, 13(4). Retrieved April 26, 2015, from

Stabiner, K. (1993, October 5). Book review: A free fall through the health-care gap: Mama might be better off dead: The failure of health care in urban America by Laurie Kaye Abraham. Retrieved April 26, 2015, from http://articles.latimes.com/1993-10-05/news/vw-42324_1_health-care-program