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.
Foreword-IntroductionChapter Summaries & Analyses
Foreword Summary
Content Warning: This section of the guide discusses systemic racism and poverty, patient neglect and abuse, drug use, homelessness, and gun violence.
Written by Dr. David A. Ansell, a Chicago-based physician known for his work combatting healthcare inequity in the United States, the foreword seeks to contextualize Mama Might Be Better Off Dead for those reading 30 years (or more) after the book’s initial publication. Ansell highlights the ways in which the healthcare issue in the United States has both developed and stayed the same since 1993. Two of the fundamental conflicts within the book—widespread healthcare inequity across the United States and concentrated poverty in the neighborhood of North Lawndale—he argues, have remained much the same. Crucially, however, “[w]e now have a better understanding of how the social, structural, and political determinants of health and health care, such as institutional racism and poverty, affect illness burden and life expectancy” (1). These understandings and terminologies are also gradually making their ways into the popular discourse (Ansell quotes President Obama toward the end of the chapter), making way for the problems themselves to be solved.
Preface Summary
Abraham provides some brief but essential exposition. The book takes place over two years, between the spring of 1989 and the spring of 1991. The names of the Banes family members have all been changed for the sake of their privacy and safety, but the names of doctors have been left unaltered, with the exception of Dr. Stone.
Introduction Summary
Abraham introduces the intimate story of the Banes family with some broad political context. In the early 1990s, just after she stopped following the Banes family closely, a series of events signaled that the American general public was highly concerned with the state of healthcare in the country: A surprise victory for the Democrats in a 1991 race for one of Pennsylvania’s Senate seats, a CBS News poll, and Bill Clinton’s presidential victory all suggested broad dissatisfaction with the prior Republican administration’s handling of the healthcare issue. Abraham argues that this issue rose to national attention because problems within the system that had been plaguing low-income patients for years suddenly reached the middle class, threatening their quality of care. She hopes to supplement the widespread quantitative information about the problem with the qualitative, humanizing story of the Banes family. After a summary of the book’s main arguments and subject matter, the Introduction ends with a political rallying cry to improve the experiences of poor families.
Foreword-Introduction Analysis
The foreword and Introduction contextualize the body of the text and imbue it with a distinctly political tone. While the book’s main chapters are undoubtedly political in their criticisms of the healthcare system and frank discussions of racism and classism, Abraham’s Introduction reads like a political manifesto. Her mission statement is delivered with conviction:
My hope is that their story—and the stories of the hospitals and clinics that are barely surviving in poor neighborhoods—will be taken seriously by the leaders calling for change in America’s health care system. Any reform plan that aspires to be both effective and just must pay careful attention to the day-to-day experiences of poor families. Anything less is not worth the effort (8).
Here, Abraham directly calls out federal lawmakers and challenges them to change the federal government’s approach to healthcare. To adopt a federal healthcare policy rooted in intimate empathy with everyday families like the Baneses is a grand mission, but one that she clearly believes is the duty of the American government. In this sense, Abraham is addressing not only the lawmakers themselves but their constituents, who have the power to enact political change with their votes. At the beginning of the Introduction, Abraham highlights the power of voters to influence healthcare policies, citing the surprise election of Pennsylvania Democrat Harris Wofford to the Senate as evidence that the healthcare system is of increasing concern to her contemporary readers. The political motivation necessary to enact change, she argues, already exists amongst the empowered middle class. She suggests that this motivation has potentially positive implications for poorer constituents like the members of the Banes family.
If Abraham’s Introduction is a manifesto written for readers in the 1990s, Ansell’s forward to the text is a manifesto for readers from 2019 onwards. He writes:
When our nation is willing to rectify the twin evils of racism and poverty, to reinvest in neighborhoods like North Lawndale, and to replace the fragmented multi-payer health insurance that disadvantages the poor with a single-payer system that universally and equitably covers all citizens, it might be possible to read Mama Might Be Better Off Dead as a curious relic of the past (1).
Written nearly 30 years after Abraham’s mission statement, Ansell’s words have the force and clarity associated with an issue that has been central to American politics for several decades. His direct call for a single-payer system is the most coherent identification of a potential solution to the problems that Abraham explores throughout the entire book. Though Abraham identifies problems, she does not name how they should be solved precisely. Furthermore, Ansell’s desire to be able to read Mama Might Be Better Off Dead as a historical document speaks to the urgency he feels to lay healthcare inequity to rest. His invocation of President Obama just prior also clarifies his left-leaning politics.
Readers are thus encouraged to engage in political dialogue with the book itself, considering where they do and do not agree with the political conclusions of its authors while they learn from the book. These two chapters emphasize that Mama Might Be Better Off Dead is a political text and a sociological one—its sociology, in fact, cannot be disentangled from its politics—and is thus a participant in broader discussions occurring in American society. Written 30 years apart, these two manifestos represent the continuation of a movement in the medical field and in American politics, to enact healthcare reform on a sweeping scale.
