Mama Might Be Better Off Dead: The Failure of Health Care in Urban America

Content warning: This section of the guide discusses systemic racism and poverty, patient neglect and abuse, and drug use.

Medicare and Medicaid, the two most closely scrutinized government healthcare programs in this book, rely on a larger system of corporations (including insurance companies, pharmaceutical manufacturers, and even hospitals) in order to function. This network came to be called the medical-industrial complex in the late 1960s. Abraham does not use this terminology in Mama Might Be Better Off Dead, but it was becoming increasingly popular around the same time that the book was published. The medical-industrial complex has been frequently criticized as fostering unsustainable conflicts of interest between the for-profit corporations and the sick populations that they are supposed to serve. In Mama Might Be Better Off Dead, this conflict of interest is illustrated in painstaking detail, constituting some of Abraham’s most scathing critiques of the American healthcare system as a whole.

Insurance is the corner of the medical-industrial complex to which Abraham pays the closest attention in Mama Might Be Better Off Dead, largely because flaws within the Medicare and Medicaid programs are politically actionable issues. She writes in the Introduction that she hopes that her observations “will be taken seriously by the leaders calling for change in America’s health care system” (8). As such, Abraham levels numerous critiques against the way the US government handles its insurance programs. She writes, “What bedevils the poor […] are Medicare’s gaps. It does not pay for medication, for transportation, for many basics that may sound wholly affordable to those with generous pensions or insurance to supplement Medicare” (4). She finds that these gaps fuel vicious cycles that undermine the quality of care for many American patients belonging to marginalized groups. For example, Medicare’s failure to cover transportation for patients like Cora ultimately prevents her from being able to get to the hospital for all of her necessary appointments. Her absences from the hospital lead to inconsistent care from doctors at best, and negligence at worst.

Furthermore, Abraham argues that other components of the medical-industrial complex are negatively impacted by the fraught insurance system, reinforcing medical workers’ inability to provide high-quality of care for all patients. Since hospitals in impoverished neighborhoods are saddled with patient populations predominantly reliant on Medicare and Medicaid, they rely on the minority of patients who have private insurance to help cover the costs that are accrued. This financial problem motivates hospitals to court wealthy patient populations and deprioritize low-income ones. When poor patients are designated second-class patients as a result of the financial logistics required to keep hospitals running, they inevitably receive lower-quality care than their wealthy counterparts. Abraham’s exposé of the Banes family’s experience within the healthcare system is full of examples of the ways in which their care was consistently deprioritized by the medical-industrial complex.