MAMA MIGHT BE BETTER OFF DEAD

Cool yet compassionate eyewitness report of an inner-city black family's struggle to cope with sickness and poverty.

Abraham, expanding on articles she wrote for The Chicago Reporter, demonstrates brilliantly just how confusing and cumbersome our national health-care system has become. From May 1989 to April 1990, Abraham followed the (pseudonymous) Banes family as its head, Jackie, cared for her bedridden diabetic grandmother; her alcoholic, partially paralyzed father; her drug-abusing husband, on thrice-weekly dialysis following kidney failure; and three young children. The labyrinthine mysteries of Medicare and Medicaid are daunting even to the Yale-educated author, yet Jackie must make what sense of them she can in order to keep her family going. Still, services that might have protected the children's health or lightened the family's burdens often aren't taken advantage of thanks to confusion about how the system works, lack of information, and the overwhelming job of simply surviving from one day to the next. Abraham concentrates on two stories—that of Jackie's grandmother, whose condition worsens, requiring hospitalization, then nursing-home care; and that of Jackie's husband, who receives a second kidney transplant. Both stories raise the issue of rationing: Could the $120,000 spent on the final months of the grandmother's life have been better utilized? How should recipients be selected for scarce organs? Abraham's depiction of the Baneses' plight reveals serious flaws in our health-care system, but the more basic problem is seen to be the devastating social illness of our inner cities, an illness no national health plan can cure.

Abraham doesn't pretend to have the answers—but she illuminates the problems with passion and skill.