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Journal of Health Care for the Poor and Underserved

Ansell, MD. In the fall of , Harris Wofford, a relatively unknown Democrat from Pennsylvania, won a seat in the U.

Senate after making sweeping health care reform the centerpiece of his campaign. The victory surprised politicians, who had expected his opponent, Richard Thornburgh, the U.

Attorney General for the first three years of the Bush administration, to coast into office. As of the spring of , it was not clear what shape health care reform would take under a Clinton administration, but the new president certainly had no shortage of proposals from which to choose.

The millions of uninsured Americans and the spiraling cost of health care received progressively more attention through the last half of the s. But what finally pushed health care reform to the top of the national agenda, many believe, was the discontent of the middle class. Middle-class families with sick children were being priced out of group insurance, even plans offered by large companies; others were stuck in dead-end jobs because preexisting medical conditions prevented them from getting insurance from a new employer; and still others lost medical coverage when they were laid off during the economic recession that began in mid In some ways, this book has nothing to do with the insurance woes of the middle class; in others, it has everything to do with them.

The grandmother, Cora Jackson, was sixty-nine years old when I first met her in May , and trying to cope with myriad chronic conditions, including high blood pressure and diabetes. She lived with her granddaughter, Jackie Banes, who cared for Mrs. Jackson as well as her own three children and her ailing husband, Robert. His kidneys failed when he was twenty-seven, and he then needed dialysis treatments three times a week to stay alive. This book provides a qualitative description that is now missing in our understanding of the much-studied problem of lack of access to care.

As a reporter who has covered public health first for a socioeconomic medical newspaper and then for an investigative publication focused on race and poverty, I had written repeatedly about the big picture: high infant mortality rates, the surging uninsured population, the scourge of AIDS. Only by following a family for an extended period of time, however, was I able to get beyond the onetime tragedies and endless flow of health statistics that make the news and begin to understand the oft-repeated phrase lack of access to care.

It can be a slippery concept to grasp, perhaps because its meaning has been deadened by overuse but also because, for the poor, it manifests itself in more subtle ways than their being uninsured—ways that are inconceivable to most of us. I came to know Jackie Banes not as a helpless victim but as a resourceful woman who tried to work the health care nonsystem to the best of her ability. The lengths to which she went to get basic care for her family are one testament to the inadequacy of health care for the poor.

The other is that her efforts so often failed. Cradle-to-grave, this family has been largely left out of a health care system that is one of the best in the industrialized world for those who are affluent and well insured and embarrassingly bad for those who are not.

No longer. Most everyone has a relative or friend who is uninsured and crossing her fingers, or who is overwhelmed by huge medical bills or insurance premiums. So far, their hardships may not have approached those the Banes family encountered when they tried to get medical care, but their experience carries a warning for us all: things will get worse, provided that private insurers continue the trend toward pushing all but the healthiest and wealthiest from their rolls, leaving the rest either uninsured or reliant on what are currently inadequate public programs.

But this book was not intended to persuade the middle class that some kind of health care reform is in their personal best interest. Just as doctors use CAT-scans and other instruments to uncover disease, this book exposes glaring inequities in health care access and quality that exist between the moneyed and the poor, inequities that existed long before the middle class began to feel the pinch. The place to start is with the uninsured.

Robert Banes could not get reliable, steady medical coverage until his kidneys failed, and it took a stroke for Tommy Markham to get the same.

Neither have held the kind of jobs that provide health insurance, and serious sickness or disability often are the only tickets to government health insurance for poor, single men under sixty-five. Though no one would choose to have a baby at Cook County, where pregnant women are herded into narrow stalls like cattle and labor side by side separated by thin curtains, Jackie was lucky in some ways to have County to go to.

Public hospitals in other cities, most notably Philadelphia, recently were forced to shut their doors when government support dried up. First, Medicaid income restrictions are so tight that the program covers less than half of the poor, defined as those Americans who fall under the federal poverty level.

Most of the working poor were and still are excluded from Medicaid and thus are uninsured, although some of their children are being progressively added to the program under reforms that began in the late s. Those who manage to get Medicaid have struggled to find decent doctors. Medicaid pays physicians well below the rates of commercial insurers, and doctors perceive the poor as difficult patients, sometimes with reason.

As for the physicians who do practice in poor neighborhoods, they may be there only because they are not good enough to work anywhere else. Poor families usually have no way of knowing whether local doctors are up to snuff, even when they have been disciplined by state medical regulators.

While Medicaid recipients are exceedingly vulnerable to the vagaries of state and federal budgets—benefits are cut when times are tight or whole categories of people are eliminated from the program—Medicare is an entitlement program that covers most Americans who are older than sixty-five and certain disabled people. Because Medicare is an entitlement, the federal government cannot cut people from the program willy-nilly.

It does not pay for medication, for transportation, for many basics that may sound wholly affordable to those with generous pensions or insurance to supplement Medicare. But such essentials strap the poor, who often end up going without. The Banes family also faced a special set of hurdles because they are African American. The long wait Robert and other blacks face when they seek kidney transplants—almost twice that of whites—is a good example. Far too often health professionals tended to downplay the effect of race on their interactions with patients or the distribution of resources, and sorting out the influence of race from poverty was not always possible.

But race had an undeniable effect in one particularly striking way. The history of hideous medical experimentation with black subjects, and its present day vestiges, made many blacks I interviewed suspicious of the medical system and sometimes compromised their access to care.

More than a year after I met the family, I discovered that Tommy Markham had participated in a kind of medical research that today would be unthinkable. His experience helps to explain the persistence of AIDS conspiracy theories among blacks, something many whites perfunctorily disregard as paranoia.

While Medicaid and Medicare have failed poor patients, they also have failed to sustain the institutions that serve them. They, too, are a major part of the story of health care for the poor. The evolution of Mount Sinai Hospital Medical Center, which started the century treating poor Jewish immigrants and ended it treating poor blacks and Hispanics, provides ample evidence of the distortions in a system driven by the relative generosity of insurers.

With Medicare and Medicaid paying at cost and below, hospitals have come to rely on a perverse system of cost-shifting: that is, covering the costs of uninsured, Medicaid, and Medicare patients by charging the privately insured higher and higher rates, which in turn increases the premiums employers and workers pay and contributes to the middle-class health care squeeze.

It is a game of dominoes, but one that Mount Sinai and other hospitals that treat mostly poor patients cannot play. Mount Sinai does not try to fight the inevitable anymore; more than perhaps any other hospital in the Chicago area, its leaders have chosen to devote the institution to serving its natural constituents, the poor.

But only great ingenuity and commitment have allowed the hospital to survive, and it still continues to finish most years in the red. Springfield [the state capital] could do it, a lot of things could do it.

Hospitals in impoverished areas nationwide have fallen in great numbers, which sets up another game of dominoes, one in which the poor and their institutions are again the losers.

The more hospitals that close, the greater the burden on those that remain and the higher the chances that they, too, will succumb. More is less for hospitals when more is more patients who cannot pay their. Open navigation menu. Close suggestions Search Search. User Settings. Skip carousel. Carousel Previous. Carousel Next. What is Scribd? Find your next favorite book Become a member today and read free for 30 days Start your free 30 days.

Create a List. Download to App. Length: pages 7 hours. 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, Laurie Kaye Abraham chronicles their access—or more often, lack thereof—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.

Both disturbing and illuminating, Mama Might Be Better Off Dead is an unsettling, profound look at the human face of health care in America. Published to great acclaim in , the book in this new edition includes an incisive foreword by David Ansell, a physician who worked at Mt.

United States History. Home Books United States History. About the author LA. Related authors. Related Categories. Introduction In the fall of , Harris Wofford, a relatively unknown Democrat from Pennsylvania, won a seat in the U. Start your free trial. Page 1 of 1. This book is a through-and-through condemnation of urban healthcare in America.

Its data and case studies underline the hard reality in urban America: people may be equal, but their healthcare is most definitely not.

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Mama might be better off dead : the failure of health care in urban America /

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Mama Might Be Better off Dead

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

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Ansell, MD. In the fall of , Harris Wofford, a relatively unknown Democrat from Pennsylvania, won a seat in the U. Senate after making sweeping health care reform the centerpiece of his campaign. The victory surprised politicians, who had expected his opponent, Richard Thornburgh, the U. Attorney General for the first three years of the Bush administration, to coast into office. As of the spring of , it was not clear what shape health care reform would take under a Clinton administration, but the new president certainly had no shortage of proposals from which to choose.

Register a free. Both disturbing and illuminating, it immerses readers in the lives of four generations of a poor,. From visits to emergency rooms and dialysis units, to trials with home care, to struggles. Washington, D. It shows how Medicaid and.

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Mama Might Be Better Off Dead

Я уверена, что они смогут сказать.

Сьюзан потеряла дар речи. Он пристально посмотрел на нее и постучал ладонью по сиденью соседнего стула. - Садись, Сьюзан.

 Сьюзан, выслушай меня, - сказал он, нежно ей улыбнувшись.  - Возможно, ты захочешь меня прервать, но все же выслушай до конца. Я читал электронную почту Танкадо уже в течение двух месяцев. Как ты легко можешь себе представить, я был шокирован, впервые наткнувшись на его письмо Северной Дакоте о не поддающемся взлому коде, именуемом Цифровая крепость. Я полагал, что это невозможно.

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