"Mama Might Be Better Off Dead"

Health care for the poor in America is so piecemeal that most patients and health professionals have resorted to working around the system. The system includes Medicaid and Medicare for those eligible, and public and private health facilities for those who fall through the eligibility cracks. Each health care provider has its own set of convoluted rules and regulations. The only solution to this bureaucratic nightmare is a governmental policy of universal health care, such as the system currently in place in Canada.

Laurie Abraham does a superb job of addressing the failure of the health care system in America in Mama Might be Better Off Dead by putting a face on human suffering. The book weaves the tale of four generations of the Banes family, black and impoverished residents of the Chicago ghetto, and their experience in trying to negotiate the system. Robert is an adult male who suffers from kidney failure. Mrs. Jackson is the invalid grandmother. Tommy is an adult male victim of a stroke caused by hypertension. Jackie, the mother of three young children, tries valliantly to secure basic health care for her family despite seemingly insurmountable odds. Ironically, the grandmother, who later dies, received more generous medical attention from the health care system during her final days than she had during the long course of her illness: "That health care may be abundant near the end of life and scarce at the beginning and middle are not unrelated" (Abraham, n.d

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cian. Some patients come to the emergency room complaining of chest pains, knowing that they cannot be refused admission and will receive priority treatment. Others truly use the emergency room as a last resort; they have been ill for a long time, yet clung to the hope that their conditions might improve spontaneously: "They got so sick waiting, waiting, waiting, because they had no health insurance and did not think they could afford a doctor until they really needed one" (Abraham, n.d., p. 96). The inner city hospitals themselves are poor, and must resort to the same type of bargain hunting and rationalization as the ghetto residents when it comes to health care. Mount Sinai's emergency room operates at a deficit of almost $2 million a year. The emergency room director cannot purchase badly needed equipment and must make do with substitutions such as styrofoam cups for splash guards to protect the staff from the spread of infectious blood diseases. Mount Sinai solves its nursing shortage by hiring nurses from temporary agencies. Ironically, these agency nurses cost the hospital more than permanent staff, thus contributing to the annual deficit. Mount Sinai is typical of community hospitals whose resources are being str

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