46 pages • 1 hour read
Laurie Kaye AbrahamMama Might Be Better Off Dead: The Failure of Health Care in Urban America
Nonfiction | Book | Adult | Published in 1993A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Chapters 3-5Chapter Summaries & Analyses
Chapter 3 Summary: “Gaps in Government Insurance for Mrs. Jackson”
Chapter 3 marks the beginning of a series of three chapters that focus on Cora’s experience as a poor, elderly, diabetes patient in the medical system. Jackie cares for Cora at home under the supervision of several nurses who visit the home to check in multiple times a week. These at-home visits are vital for relieving Jackie of some of her burdens, but at the same time, she feels scrutinized and judged by the nurses. Furthermore, Jackie struggles to secure the coverage she is entitled to for the at-home care, especially since some of Cora’s at-home needs are deemed “unnecessary” by Medicare standards.
Sister Mary Ellen, a Catholic nun who has lived and worked as a social worker in North Lawndale since the 1960s, arrives at the apartments and sets about advocating on behalf of Cora with various healthcare providers. Sister Mary Ellen was called a “soul sister” by members of the Black Power movement. Chief among the problems she hopes to solve is acquiring Cora’s green card, which is regranted monthly depending on whether she can meet a threshold of being “medically needy” for that cycle. Proving this means acquiring all of the medical bills and documentation and submitting them to the public aid office in time for the monthly deadline, which is less easy than it sounds:
If Mrs. Jackson meets her spend-down on the twentieth of the month, she qualifies that day for the rest of the month. So ten days after she becomes eligible, her coverage expires. As Jackie says, “By the time I get the card, it’s time to do it again” (51).
Cora and Jackie begin to feel that there is a conspiracy at the public aid office to prevent her grandmother from receiving the care she needs. Social workers like Sister Mary Ellen provide help, but they are not perfect safeguards for the flaws in the system. Furthermore, as coverage for Cora’s medical needs continues to be fickle, Jackie rations her medicine, thinking that it is the only affordable option.
Chapter 4 Summary: “Fitful Primary Care Fails Mrs. Jackson”
Symptoms begin to indicate that Cora’s second leg may need to be amputated. Doctors require that she return to the hospital at least once a week to monitor the situation, but transportation to the hospital is expensive, and Jackie has to pick and choose which appointments to take her grandmother to. Every time she asks doctors to simply admit Cora to the hospital to bypass the issue of transportation, but doctors cannot justify how much that would cost the hospital. This cycle is what led to Cora’s two prior amputations: first, the amputation of part of her foot; and second, the amputation of the whole leg. To make matters worse, the two family doctors, Dr. Marino and Dr. Gurevich, fail to provide Cora with attentive, tailored care. Abraham learns that Dr. Marino even failed a peer review, but the Banes family is entirely unaware of his history of inadequate practice.
Chapter 5 Summary: “Mrs. Jackson’s Melancholy”
Restricted to the apartment in her bed or wheelchair, Cora’s mental health begins to deteriorate rapidly. One doctor prescribed her antidepressants during her time in the hospital but quickly pulled her off of the medication before they could take effect. The doctors also fail to inform the Banes family about Home Psychcare, a grant-funded program that provides psychiatric help to patients who are homebound, even though an improvement in her mood might also correspond to an improvement in her physical condition.
Turning back to Sister Mary Ellen, Abraham outlines how, despite being very committed to helping her cases, the nun is too overworked and too professionally restricted to focus on anything other than Cora’s physical needs. As the medical professionals and social workers in their lives fail to stop Cora’s mental health from deteriorating, Jackie becomes increasingly confused by her grandmother’s unstoppable melancholy, not knowing to seek out counseling herself.
Chapters 3-5 Analysis
This trilogy of chapters within the larger narrative of the book helps to center Cora Jackson as one of Mama Might Be Better Off Dead’s central protagonists. Because Abraham is unable to get as close to Robert as she might like while Jackie is entirely accessible, the relationship between grandmother and granddaughter takes center stage. The progression of Cora’s health is an arc that is carried throughout the entire book. In this portion, Abraham establishes three key obstacles that prevent Cora’s physical health from improving: inconsistent healthcare coverage, inconsistent care from doctors themselves, and the decline of her mental health as a result of her immobility. These pieces of information are essential for understanding Cora’s fate at the end of the book: her move to a nursing facility and death.
Alongside the critiques of how the healthcare system functions for Medicaid recipients and poor Medicare recipients, a vivid human story begins to emerge in these chapters. In particular, familial relationships, as exemplified by the love shared by Jackie and Cora, are presented as a casualty of healthcare inequity frequently forgotten about by policymakers. “I get angry because she won’t talk to me” (92), Jackie admits to Abraham as she watches her grandmother’s depression progress helplessly. Without adequate assistance from healthcare workers, resentment begins to fester between Jackie and her grandmother. In moments like these, interpersonal strain is clearly one of The Negative Effects of the American Medical-Industrial Complex. As Medicare and Medicaid are not equipped to provide Cora with the mental health support she needs, her relationship with Jackie continues to sour.
At the same time that she critiques the healthcare industry as a whole, Abraham characterizes individual healthcare workers sympathetically, especially Sister Mary Ellen. The time devoted to profiling well-meaning medical professionals throughout the book suggests that Abraham views the larger healthcare system as undermining those who work in it, as well as the patients themselves. Sister Mary Ellen’s desire to help patients like Cora Jackson is presented as wholeheartedly sincere. However, as Abraham observes, an overwhelming caseload, limited time, and government restrictions prevent her from helping individual cases to the fullest extent: “Many home social workers—limit themselves to connecting patients with needed services because, although Medicare rules allow counseling, the federal insurer traditionally has emphasized nursing and other clearly ‘medical’ care” (91). Even in the earliest stages of the book, it is evident that healthcare workers and patients both are operating within a system that incapacitates them. The implicit question is what the purpose of such a healthcare system is, if not to enable comprehensive healthcare for citizens and permanent residents who need coverage.
As the book progresses, a cast of characters and their roles within the American healthcare issue become increasingly clear: Impoverished patients struggling to survive and beleaguered healthcare workers are the protagonists, while larger, profit-motivated entities like insurance companies and government agencies are antagonists. This clear delineation between what is good and what is bad throughout the book underscores its format as a journalistic exposé with political motivations. Abraham brings her own individual perspective to the narrative, even though that perspective is based on years of research.
