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

Having established the fraught working conditions at Mt. Sinai in the book’s present day, Abraham provides an overview of the hospital’s history up to that point. This history helps to explain why the emergency room workers of the late ‘80s and early ‘90s found themselves overwhelmed and under-resourced. Mt. Sinai was originally established as a charity hospital for North Lawndale’s Eastern European Jewish community in the first half of the 20th century. The other major Jewish hospital in Chicago, Michael Reese, served primarily German Jews, and the Eastern European Jews did not feel welcomed there. However, despite animosity from members of the Jewish community and the Associated Jewish Charities of Chicago board, which viewed Michael Reese as the only worthwhile hospital in the city, Mt. Sinai was able to garner enough funding for steady growth in its earliest years of operation.

However, in the mid-20th century, when Jewish patients started leaving the neighborhood for more affluent parts of the city, the administration at Mt. Sinai faced an existential dilemma. Should they continue their charity work on the West Side, now with a Black patient population, or should they court wealthy patients who could keep the hospital afloat? At first, they tried to do both, but these efforts were minimally successful and resulted in what many saw as discrimination against Black patients. Abraham notes that tensions between Jewish and Black donors prevented Mt. Sinai from receiving copious funding from either group. They even considered relocating to a different part of the city and merging with Michael Reese, but by the time these plans were put in place, the hospital did not have enough money to enact them. Therefore, Mt. Sinai remains a hospital committed to treating its community’s poor Black patients, barely scraping by every year.

Abraham returns to the story of Tommy Markham. He receives medical care at Lawndale Christian Health Center, which is run by Dr. Arthur Jones. The health center is another medical institution that scrapes by on meager government funding. In his appointments with Dr. Jones, Tommy dodges questions, wavering between being willing to give up some of his bad habits (like smoking and drinking) and not. Abraham uses these conversations as a gateway into a discussion of the Republican government’s position on “individual responsibility” for healthcare. Under President George H. W. Bush, Dr. Louis Sullivan, Secretary of Health and Human Services, began to promote the idea that individual Americans should be held responsible for their own healthcare circumstances. This platform, Abraham argues, ignores the plethora of involuntary factors that impact the health of people like Tommy, such as race and socioeconomic status.

Abraham rejoins Jackie at the apartment as she tries to take care of the three children and Cora simultaneously. Cora frequently demands that Jackie remake food for her, and moments like this wear heavily on Jackie’s nerves. Five years prior, conservative policymakers pushed through legislation in Congress that resulted in a spike in home healthcare denials by Medicare; the program increasingly deemed at-home health services “unnecessary” and therefore unfundable. Although these policies were reversed in 1989, agencies remain cautious when it comes to providing home services, fearful that the government will simply reverse its policies once more. As a result, some crucial services for Cora, including her physical therapy, were cut short for fear that they would not be fundable. These sacrifices within Cora’s healthcare plan have made Jackie’s experience caring for Cora increasingly difficult: “Better mobility for Mrs. Jackson would have made Jackie’s job easier” (150).

As the months wear on, Jackie begins to consider placing Cora in a nursing home. Jackie’s daughter Latrice is doing poorly in school for the first time ever, and this shift can be attributed, in part, to the fact that Jackie does not have enough time to facilitate her schoolwork. However, again, the decision to transfer Cora to a nursing home comes with potentially prohibitive costs. Even worse, Jackie feels guilty that such a decision would make Cora feel abandoned. The burnout associated with being a full-time caregiver is not something that can be alleviated without proper funds. Therefore, Jackie continues to feel boxed in and unable to provide her grandmother with adequate care.