Application of Mama Might Be Better Off Dead Book to Health Inequalities

Mama Might Be Better Off Dead Book Paper

Abstract

The purpose of this paper is to identify the healthcare disparities and inequalities, major health care expansions such as Medicare Part D and The Affordable Care Act, the role of communication in the trajectory of illness, rational and reasoning for extensive and expensive Care, and the role of the Christian nurse that has impacted the Bane’s family. These problems in the book where clearly stated and very relevant to today’s society. After reading, “Mama Might Be Better Off Dead” and doing further research, our healthcare system is very gapped. From the doctors to the patient communication to the insurance given to people in poverty. The financial burden of Medicare and Medicaid played a significant role in the Bane’s family.

Mama Might Be Better Off Dead Paper

Introduction

 Healthcare is a long, ongoing issue in America. People constantly struggling with what they can receive and what they cannot receive, along with worrying about the costs. For the Bane’s family they dealt with many financial burdens; Jackie Bane’s had to worry about not only herself, but her grandmother, father, and husband. Mrs. Jackson, the grandmother of Jackie, discusses the details of how Medicare wasn’t enough at the end of her life. Medicare and Medicaid played a big role is in this book. “Mama Might Be Better Off Dead” emphasizes on the struggles throughout urban healthcare system and how shows the true failure of health care in urban America.

Health Care Disparities and Inequalities

 Health care inequalities have become very usual, not only in today’s society, but even back when the book was published in 1993. The book examines an area in Chicago, called North Lawndale neighborhood, a place in Chicago that is considered one of the poorest African-American neighborhoods. Health care inequalities have become very common in America and this book helped highlight on this problem. Health care reform is vital, especially for the impoverished, specifically, with the Bane’s family. The family all needed care, Robert Banes, encountered kidney failure at 27, Tommy Markham was an alcoholic with high blood pressure and endured a stroke at 48, and Cora Jackson, a diabetic, whose legs were amputated and had been dealing with depression, they were all struggling with the health care were poor, but sadly, were all not eligible enough to receive that financial support for things such as hospitalizations, medications, transportation, etc. Tommy mentions in the book, “The poor are more likely to be uninsured than anybody else, and as Tommy Markham said: ‘You could be damn near dying, and the first thing they ask is ‘Do you have insurance?” (Abraham, 1994, pg. 3). This clearly has impacted the Bane’s family in a negative way. Health care should not be affected by what insurance one has. One person should not be treated differently because they have better insurance or health care, that is not fair. A human shouldn’t have to be near death to receive the right healthcare.

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The book also mentions how Robert Banes had to endure his kidneys failing to get a sort of medical coverage, along with Tommy Markham suffering a stroke. Abraham focuses in her book that, “Little support can be found for the notion that Medicare assures the same quality and quantity of care to the middle-class and poor elderly” (Abraham, 1994, pg. 62). As a future nurse, I feel that care should be given the same way all around. Everyone should receive the same quality and quantity of care, no matter what the circumstances are. As nurses, we should bring advocacy to health care disparity.

Major Health Care Expansions

Medicare Part D

 In 2006, The Medicare Modernization Act Prescription Drug Benefit (Part D) was passed. Medicare plays an enormous role in the book. One reason the role is significant in the book is because Medicare Part D affected Mrs. Jackson and her health substantially. Medicare would not cover her medication, which clearly is needed with her specific health conditions, Diabetes, and would also not pay for transportation or basic requirements such as adult diapers. The poor often ends up going without these needed essentials because of their situation and health care. Medicare only covered some medical bills. Robert also got Medicare but only after his kidneys stopped working. Medicare still pays much better than Medicaid, and its lower rates have not seriously curtailed the elderly’s access to city doctors and hospitals. Medicaid covers Medicare, but without the spend down approval. When discussing Medicare and transportation, the book discusses how Jackie faced the prospect of coming up with $70 round trip to Mount Sinai, the emergency department, about a mile away. Medicare pays for 80% if Mrs. Jackson’s doctors’ bills, but it does not pay to get her to and from their offices. An article regarding Medicare Part D and mortality states, “The majority of studies examining Medicare Part D have focused on its effects on drug utilization and out-of-pocket spending. The introduction of Medicare Part D was associated with a 13% increase in elderly prescription drug use and an 18% reduction in out-of-pocket drug spending” (Huh, J. & Reif, J., 2017, pg. 19). This article really emphasizes what role Medicare Part D plays in an elderly person’s life and how even though many people struggle with money, Medicare Part D does play a beneficial part in some respects. Money was a big issue for the Bane’s family, that is why Medicare Part D did not really help has much as they expected. If Medicare Part D would have been available, the Bane’s family would have really benefited, such as Robert being able to prevent his renal failure and get Dialysis. The financial burden was significant.

Affordable Care Act

 The Patient Protection and Affordable Care Act (PPACA) was created in 2010, it is often called “Obamacare”. President Obama took the stewardship of Obamacare and has changed millions of those who have been uninsured in America. In the book, Robert struggled with the fact of not being poor, not being rich, not being old, to receive care. Abraham writes, ““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 insurance, and serious sickness or disability often are the only tickets to government health insurance for poor, single men under sixty-five” (Abraham, 1994, p. 3). If the Affordable Care Act would have been in place for the Bane’s family, there health outcomes would have changed drastically. An article, Racial Identity and Healthcare Preferences, states, “With the passage of the Affordable Care Act, many are hopeful that unequal access to healthcare services will be reduced. However, it seems ensuring different populations utilize healthcare services equitably in relation to need is more complicated than widely believed, and perhaps less amendable to legislation alone” (Chaitoff, Wickizer, White, 2015, pg. 44-45). This article really emphasizes how the Affordable Care Act impacted African American’s significantly with the reduction of unequal services constantly given throughout America. Before the Act, many races were treated differently due to their color and unfortunate insurance.

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The Affordable Care Act does a great job focusing on cultural sensitivity. The Act doesn’t specifically focus on one cultural group, it is open to any and all. In another article, Racial/Ethnic Variation in the Impact of Affordable Care Act on Insurance Coverage and Access Among Young Adults, states, “Future research should examine in the impacts of ACA implementations, which included individual health insurance marketplaces with premium and cost-sharing subsides and the expansion of Medicaid for low-income families…. ACA extension of parental insurance significantly increased in the number of young adults with health insurance. Our findings suggest that mitigating racial disparities should be explicit consideration when developing national health insurance reform policy” (VanGrade, Yoon, Luck, Mendez-Luck, 2018, pg. 548). This Act has changed lives for many people and would have definitively changed lives in the Bane’s family, had it been in place.

Role of Communication in the Trajectory of Illness

 Communication is a significant role in the trajectory of illness. For example, Cora Jackson’s case a lack of communication resulted in her death. Her death could have been avoided had her doctor and home health care nurse documented appropriately and had kept in continuous contact with each other. The home health care nurse was not aware that Mrs. Jackson was routinely missing appointments, which was resulting in missing her levels of Coumadin, and that lead to never being able to monitor Mrs. Jackson’s PT level. Mrs. Jackson kept taking Coumadin per her doctor’s orders, which was because she missed her appointments with Dr. Gurevitch, due to inadequate transportation. Establishing a doctor and patient relationship is very important as well. In the book it states, “Doctors in poor neighborhoods often have to abandon their patients when they are hospitalized. And they may not connect well with their patients in the first place. In 1989, approximately eleven doctors had storefront practices in North Lawndale” (Abraham, 1994, p. 230). The communication is sometimes not just the doctors fault, it also be the patients fault. Even though Mrs. Jackson could not gain transportation to and from the clinic, it was also a miscommunication on her part as well.

Without communication between doctors and nurses, so much can go wrong. An article, Communication Skills Workshop for Doctors, Resulting in Better Healthcare Delivery, states, “Communication plays the most important role in determining the tone of patient-doctor relationship. Dissatisfaction, clinician abandonment and ineffective or bad communication. Communication also play an important role in deciding the end of life care and palliation. In the light of the aforementioned facts, the importance of effective communication cannot be over emphasized” (Khan, Alvi, Kafeel, Zaffar, 2017, pg. 107). This is an essential article to read over because of the way it focuses on how the communication is everything in the healthcare system. If the doctor and nurse do not have a sense of communication, things can be made unclear, resulting in patients dying, just like what happened to Cora Jackson. This can be considered patient safety errors related to miscommunication.

Rational and Reasoning for Extensive and Expensive Care

 Healthcare is very expensive, and the average person could not afford it without insurance, and in some cases, even with insurance it is still hard to afford. Abraham states, “Although hospitals and doctors certainly could save money with increased efficiency and Americans could decide to devote more than the current 12.2% of gross national product to health care, there is growing recognition that there will never be enough money for everyone to have all the care they want when they want it” (Abraham, 1994, p. 239). Money will always be a problem in health care and certainly was a problem for Mrs. Jackson. The Bane’s family never had the financial funds to help support their health care, and in results, Mrs. Jackson died. Abraham then states, “But as Mrs. Jackson could have arrested, health care has always been rationed, not by procedure or age but by ability to pay and by the nature of government programs, and not at the end of life, but earlier, when debilitating diseases might have been treated or prevented” (Abraham, 1994, p. 239). The ability to pay should not determine a patient’s care or even be the determining factor in if one is going to live or die. Social justice needs to be taken in to affect because health care is human rights. No human should go without health care. Health care extensive and expensive care is ridiculous. Mama Might Be Better Off Dead shows a significant amount in how being poor and African-American plays a role in a healthcare. 

Role as a Christian Nurse

 As a Christian nurse, the role is to not only provide care to patients and advocate but to bring spiritually into it. If the Bane’s family had a Christian nurse, that nurse could have not only provided prayer continuously but provided a preacher to come in and support the family, with scripture and the word of the Lord. In times of need, which is where the Bane’s family stood, is when God is needed most. I believe if the Bane’s family had a Christian nurse, there outcome on their healthcare situation, could have maybe turned out differently. A Christian nurse could have brought beneficence to the Bane’s family, with being able to sympathize to their feelings and help relate to their thoughts.

Conclusion

This book was really an eye-opener for me. Healthcare is a basic right for all humans, I did not realize how many problems there are in the healthcare system. This book focused on what it was like being poor and attempting to be provided with appropriate healthcare. As a future nurse, we need to bring not only awareness to the healthcare system but also cultural awareness. As I read Mama Might Be Better Off Dead and did research on this topic, I learned how significant one’s race and insurance play in the healthcare system. Not only were the Bane’s family poor but they were African-American, and I personally felt they were treated differently not only because of their poverty but also because of their color. Many of these problems could have been avoided if the Affordable Act Care program was in place. Being a professional nurse and treating someone means providing the best care possible, no matter what the color of their skin is or how they are going to pay for the care they are given. At the end of the day, none of that matters, what matters is how, as a nurse, I am going to give my care. This book has impacted my future nursing profession in a positive way because I felt individually involved with this family as a read this book.

References

• Abraham, L. (1994). Mama Might Be Better Off Dead: Failure of Health Care in Urban America. Chicago, IL: University of Chicago Press.
• Chaitoff, A. M., Wickizer, T., & White, I. (2015). Racial Identity and Healthcare Preferences. Journal Of Health Disparities Research & Practice, 8(4), 30-50
• Huh, J. & Reif, J. (2017) Did Medicare Part D Reduce Mortality? Journal of Health Economics, 5317-37. Doi:10 1016/j.jhealeco.2017.01.005
• Khan, F. H., Khan, M. F., Alvi, R. D., Kafeel, S., & Zaffar, M. (2017). Communication Skills Workshop for Doctors Resulting in Better Healthcare Delivery. Pakistan Armed Forces Medical Journal, 67(1), 107-111
• VanGrade, A., Yoon, J., Luck, J., & Mendez-Luck, C.A. (2018). Racial/Ethnic Variation in the Impact of the Affordable Care Act on Insurance Coverage and Access Among Young Adult. American Journal Of Public Health, 108(4), 544-549. Doi:10.2105/AJPH.2017.304276’