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.
Background
Political Context: The Healthcare Issue in America at the Turn of the 21st Century
Mama Might Be Better Off Dead addresses healthcare access and inequity in the United States in the late 1980s and early 1990s. This issue has continued to be at the forefront of American politics up to the present day. This book, however, should be understood within its particular historical context, rather than in terms of healthcare politics as they stand today. In particular, presidential politics are a key component of this context.
Abraham nods to presidential politics throughout the book. In the Introduction, she highlights Bill Clinton’s decision to place healthcare at the center of his presidential campaign platform, understanding that Americans were fundamentally dissatisfied with their lack of access to affordable healthcare. The body of the book rewinds from that point, seeking to pinpoint where such dissatisfaction came from. In Chapter 8, she lands on the policies of President George H. W. Bush’s Republican administration, which were based on the notion that individual Americans should be held accountable for their own health. Bush’s Secretary of Health and Human Services, Dr. Louis W. Sullivan, spearheaded this line of rhetoric. Abraham quotes his remarks at a 1990 meeting of the National Medical Association: “Each American must feel a sense of urgency—the need to stop poor health practices, and to maintain good health practices […]. We must remember that good health is a responsibility we really have to each other” (140). This rhetoric ultimately promoted the idea that the government should have minimal obligations to provide healthcare for citizens and lawful permanent residents.
Subsequent Democratic administrations, namely the Clinton and Obama administrations, took aim at this individualistic approach to healthcare. Most notably, the Affordable Care Act was passed in 2010 under President Obama’s leadership, marking the largest expansion of access to Medicaid since the program’s inauguration in 1965. However, at the time of this book’s publishing, such expansions had not even been conceived of yet, and the Banes were cornered in a healthcare system that blamed them for medical issues that were sometimes out of their control. Even with the political changes that have occurred since then, however, the 2019 foreword cautions that “[t]he problems of health care access, coverage, and cost […] are unresolved and divisive national issues, despite the passage of the Affordable Care Act and its expansion of health care coverage in some parts of the country, including Chicago” (1). Contemporary readers are thus challenged to understand the text within its particular historical context without dismissing it entirely as an artifact of the past.
Geographic Context: North Lawndale, Chicago
North Lawndale is one of Chicago’s 77 designated neighborhoods, located six miles west of the city’s downtown Loop area. The area was first annexed by the city of Chicago in 1869, and in the latter half of the 19th century, it was predominately populated by Czech immigrants from the Austro-Hungarian Empire. As the 20th century progressed, Eastern European Jews came to the neighborhood, by way of Maxwell Street closer to downtown, having fled pogroms and persecution in their homelands. By the 1950s, as Jewish residents left for other parts of the cities, North Lawndale gradually became a predominantly Black neighborhood. The transition from Jewish to Black residents is of particular concern within Mama Might Be Better Off Dead, since Jewish hospitals like Mt. Sinai took on Black patient populations when their originally intended patient base left the area. The text suggests that this has led to Misunderstandings Between Medical Workers and Marginalized Patients.
Since 1980, widespread poverty in North Lawndale has only worsened. Adjusted for inflation, the median household income in the neighborhood has decreased by $4,000; this is an especially stark statistic when compared with comparable neighborhoods, where median income has increased (University of Illinois Chicago, North Lawndale Databook, i). Despite being a historically Black neighborhood, Black residents are leaving the area at a consistent rate and have been doing so since the period in which the text is set. The University of Illinois, Chicago found that the Black population of North Lawndale decreased by 9.7% between 2010 and 2020 (North Lawndale Databook, ii). In the present, most residents continue to be from low-income Black communities, but the number of vacant lots is increasing as longtime residents choose to leave (Chicago Metropolitan Agency for Planning, North Lawndale Community Snapshot). Attempts to revitalize the neighborhood are ongoing.
