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

The blood vessels in the kidneys are called the glomeruli, and they filter urine out of blood. Glomerulosclerosis is scarring in these blood vessels. It can be caused by diabetes or other kidney problems. Dialysis or a kidney transplant can be necessary in more severe cases. Robert has this condition, as Abraham highlights in the text.

“Green card” is a colloquial term used by characters in the book to refer to the card issued by the government to families who qualify for Medicaid. The card represents access to the care that the Banes family so desperately needs, and its necessity is a recurring topic throughout the book, especially in Chapter 3. Because of the spend-down restrictions on her coverage (see the “spend-down” entry below), Cora’s green card is frequently revoked for a month before she has the chance to qualify again. The fickle nature of the green card, in combination with its indispensability, makes it just one of the many frustrating obstacles to care that Abraham observes the Banes family managing daily. This card is different from its homonym, the colloquial term for permanent resident cards in the United States, also commonly referred to as “green cards.”

Medicaid is the US federal government’s insurance program for citizens and lawful permanent residents who qualify as having prohibitively low income (eligibility varies by state and has changed over time). It was established in 1965 as part of President Lyndon B. Johnson’s Great Society program and was expanded in 2010 under the Affordable Care Act. In Mama Might Be Better Off Dead, the issue of qualifying for Medicaid is a huge concern that impacts the Banes family’s ability to get the healthcare they need, especially Cora, whose eligibility wavers back and forth throughout the book. As Abraham observes, patients whose income is just above the cutoff line for Medicaid are frequently still too poor to afford their own healthcare, resulting in a complete inability to receive the medical attention that they need to survive.

Medicare is the US federal government’s insurance program for those who are either over the age of 65 or disabled. Both Cora and Robert qualify for Medicare, since Cora is elderly and Robert’s glomerulosclerosis qualifies as a disability. As such, Medicare plays an essential role in enabling the Banes family to afford their medical bills, but the intricacies of the program are confusing and undermine their quality of care. The confusing relationship between Medicare and Medicaid is best summed up by Jackie’s passing statement in Chapter 9: “For a long time, I was thinking that Medicare and Medicaid were the same thing” (159). Jackie’s inability to juggle the quirks of Medicare and Medicaid at the same time, much less distinguish the two programs from one another, is one of the book’s central conflicts and one that Abraham argues is by design.

Risk rating is a process that occurs within the private insurance world, in which individuals who present a higher risk of cost to the insurance company are charged higher rates for their insurance. Abraham traces the practice, in part, to the popular notion of individual responsibility for health, which, in effect, places sole blame for medical complications on patients and justifies financially punishing them for their supposed “mistakes.” Such ideology extends to the government’s inconsistent treatment of poor and marginalized communities, who have higher medical risks because of societal factors that are beyond their control but are nonetheless dealt with blame by medical professionals and insurance programs that only consider their individual actions in regard to self-care.