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Mama Might Be Better Off Dead: The Failure of Health Care in Urban Americaby Laurie Kaye Abraham
Synopses & Reviews
When Andrea Louise Campbelland#8217;s sister-in-law, Marcella Wagner, was run off the freeway by a hit-and-run driver, she was seven-and-a-half months pregnant. She survivedand#151;and, miraculously, the baby was born healthy. But thatand#8217;s where the good news ends. Marcella was left paralyzed from the chest down. This accident was much more than just a physical and emotional tragedy. Like so many Americansand#151;50 million, or one-sixth of the countryand#8217;s populationand#151;neither Marcella nor her husband, Dave, who works for a small business, had health insurance. On the day of the accident, she was on her way to class for the nursing program through which she hoped to secure one of the few remaining jobs in the area with the promise of employer-provided insurance. Instead, the accident plunged the young family into the tangled web of means-tested social assistance.
As a social policy scholar, Campbell thought she knew a lot about means-tested assistance programs. What she quickly learned was that missing from most government manuals and scholarly analyses was an understanding of how these programs actually affect the lives of the people who depend on them. Using Marcella and Daveand#8217;s situation as a case in point, she reveals their many shortcomings in Trapped in Americaand#8217;s Safety Net. Because American safety net programs are designed for the poor, Marcella and Dave first had to spend down their assets and drop their income to near-poverty level before qualifying for help. Whatand#8217;s more, to remain eligible, they will have to stay under these strictures for the rest of their lives, meaning they are barred from doing many of the things middle-class families are encouraged to do: Save for retirement. Develop an emergency fund. Take advantage of tax-free college savings. And, while Marcella and Daveand#8217;s story is tragic, the financial precariousness they endured even before the accident is all too common in America, where the prevalence of low-income work and unequal access to education have generated vastand#151;and growingand#151;economic inequality. The implementation of Obamacare has cut the number of uninsured and underinsured and reduced some of the disparities in coverage, but it continues to leave too many people open to tremendous risk.
Behind the statistics and beyond the ideological battles are human beings whose lives are stunted by policies that purport to help them. In showing how and why this happens, Trapped in Americaand#8217;s Safety Net offers a way to change it.
This critically acclaimed book is an unsettling, profound look at the human face of health care. Both disturbing and illuminating, it is the story of four generations of a poor African American family coping with the devastating illnesses that are all too common in America's inner cities. From visits to emergency rooms and dialysis units, to trials with home care, to struggles for Medicaid eligibility, Abraham chronicles the Banes family and their access (or lack of access) to medical care. Embedded in the family narrative is a lucid analysis of the gaps, inconsistencies, and inequalities the poor face when they seek health care.
Campbelland#8217;s book revolves around the experiences of her brotherand#8217;s family when his pregnant wife suffered a horrific accidentand#151;leaving Marcella a quadriplegicand#151;without health insurance. Yet the accident was more than a physical and emotional tragedy. It was an economic tragedy that hurtled Marcella and Dave out of what passes today as the middle class into the world of means-tested social assistance programs. A world where, like tens of millions of other Americans, they find themselves trapped in the and#147;safety netand#8221; of public programs for the poor. As a social policy expert who has taught at Harvard and at MIT, Campbell thought she knew a lot about these programs. This eye-opening and disturbing book tells us what she learned. Passionate, but clear-eyed, it compellingly traces her brotherand#8217;s familyand#8217;s Dickensian odyssey through Americaand#8217;s health insurance and other social insurance programs. Using her brotherand#8217;s family and her own situation as examples, she reveals the many shortcomings and inequities of America social policy that leave people exposed to tremendous risk. Nowhere else among advanced industrialized democracies can a single accident render a person bankrupt, or forever impoverished. Nowhere else can oneand#8217;s economic fate differ so much from one state to another within the same country. And, far from being too generous and breeding dependency, many of our means-tested programs are perversely structured not to give people a hand up, but to keep them trapped in poverty. Behind the statisticsand#150;beyond the ideological battles over social assistance programsand#150;are human beings whose lives are molded, distorted, and diminished by the very policies purported to help them. In showing how and why this happens, Trapped in theSafety Net offers a way to change it.
Mama Might Be Better Off Dead is an unsettling, profound look at the human face of health care. Both disturbing and illuminating, it immerses readers in the lives of four generations of a poor, African-American family beset with the devastating illnesses that are all too common in America's inner-cities.
The story takes place in North Lawndale, a neighborhood that lies in the shadows of Chicago's Loop. Although surrounded by some of the city's finest medical facilities, North Lawndale is one of the sickest, most medically underserved communities in the country. Headed by Jackie Banes, who oversees the care of a diabetic grandmother, a husband on kidney dialysis, an ailing father, and three children, the Banes family contends with countless medical crises. From visits to emergency rooms and dialysis units, to trials with home care, to struggles for Medicaid eligibility, Abraham chronicles their access (or lack of access) to medical care.
Told sympathetically but without sentimentality, their story reveals an inadequate health care system that is further undermined by the direct and indirect effects of poverty. When people are poor, they become sick easily. When people are sick, their families quickly become poorer.
Embedded in the family narrative is a lucid analysis of the gaps, inconsistencies, and inequalities the poor face when they seek health care. This book reveals what health care policies crafted in Washington, D. C. or state capitals look like when they hit the street. It shows how Medicaid and Medicare work and don't work, the Catch-22s of hospital financing in the inner city, the racial politics of organ transplants, the failure of childhood immunization programs, the vexed issues of individual responsibility and institutional paternalism. One observer puts it this way: "Show me the poor woman who finds a way to get everything she's entitled to in the system, and I'll show you a woman who could run General Motors."
Abraham deftly weaves these themes together to make a persuasive case for health care reform while unflinchingly presenting the complexities that will make true reform as difficult as it is necessary. Mama Might Be Better Off Dead is a book with the power to change the way health care is understood in America. For those seeking to learn what our current system of health care promises and what it delivers, it offers a place for the debate to begin.
About the Author
Andrea Louise Campbell is professor of political science at the Massachusetts Institute of Technology. She is the author of How Policies Make Citizens and coauthor of The Delegated Welfare State.
Table of Contents
1: "Where crowded humanity suffers and sickens": The Banes family and their
2: The rigors of kidney dialysis for Robert Banes
3: Gaps in government insurance for Mrs. Jackson
4: Fitful primary care fails Mrs. Jackson
5: Mrs. Jackson's melancholy
6: The inner-city emergency room
7: One hospital's story: How treating the poor is "bad" for business
8: Who's responsible for Tommy Markhams's health?
9: Jackie Banes's "patient"
10: Empty promises: Preventive care for the Banes children
11: Robert Banes plays the transplant game
12: The Banes family and white doctors
13: Life-sustaining technology
14: Amazing grace
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