Content warning: This section of the guide discusses systemic racism and poverty, patient neglect and abuse, and drug use.

Medicare and Medicaid, the two most closely scrutinized government healthcare programs in this book, rely on a larger system of corporations (including insurance companies, pharmaceutical manufacturers, and even hospitals) in order to function. This network came to be called the medical-industrial complex in the late 1960s. Abraham does not use this terminology in Mama Might Be Better Off Dead, but it was becoming increasingly popular around the same time that the book was published. The medical-industrial complex has been frequently criticized as fostering unsustainable conflicts of interest between the for-profit corporations and the sick populations that they are supposed to serve. In Mama Might Be Better Off Dead, this conflict of interest is illustrated in painstaking detail, constituting some of Abraham’s most scathing critiques of the American healthcare system as a whole.

Insurance is the corner of the medical-industrial complex to which Abraham pays the closest attention in Mama Might Be Better Off Dead, largely because flaws within the Medicare and Medicaid programs are politically actionable issues. She writes in the Introduction that she hopes that her observations “will be taken seriously by the leaders calling for change in America’s health care system” (8).