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

Mama Might Be Better Off Dead addresses healthcare access and inequity in the United States in the late 1980s and early 1990s. This issue has continued to be at the forefront of American politics up to the present day. This book, however, should be understood within its particular historical context, rather than in terms of healthcare politics as they stand today. In particular, presidential politics are a key component of this context.

Abraham nods to presidential politics throughout the book. In the Introduction, she highlights Bill Clinton’s decision to place healthcare at the center of his presidential campaign platform, understanding that Americans were fundamentally dissatisfied with their lack of access to affordable healthcare. The body of the book rewinds from that point, seeking to pinpoint where such dissatisfaction came from. In Chapter 8, she lands on the policies of President George H. W. Bush’s Republican administration, which were based on the notion that individual Americans should be held accountable for their own health. Bush’s Secretary of Health and Human Services, Dr. Louis W. Sullivan, spearheaded this line of rhetoric. Abraham quotes his remarks at a 1990 meeting of the National Medical Association: “Each American must feel a sense of urgency—the need to stop poor health practices, and to maintain good health practices […].