Employment and Health Care

One of my friends, a surgical resident, told me about a case in which a patient who recently lost her job went to the emergency department. The surgical team recommended admission and observation overnight. However, along with losing her job, she lost her health insurance, and as a result, she was concerned that she could not afford the emergency department bill, let alone a hospital stay. She left the hospital against medical advice despite my friend having a long conversation about her well-being and recommending that she stay.

Stories like this stun me. The loss of a job and health insurance can tip a patient with medical problems over the edge; the patient may no longer be able to see her physicians or pay for medications, may experience stress and anxiety, may be unable to exercise or eat well, may start drinking. And all of a sudden, her well-managed medical problems spiral out of control. Although a patient may know that she has to find health coverage, that's hardly a priority if she's worried about making the rent or mortgage, affording food, caring for children, finding other employment. Now she's in the ED, and she makes the perfectly rational decision not to bankrupt her family. But what if that health concern becomes something much more serious, and after going home, she sustains permanent or irreversible injury, requires an ambulance, or lets a potentially treatable disease become too widespread?

Why do we tie our health care to employment? Why do we link something that everyone ought to have to employment if 7-8% of the population is unemployed? Should a decision about someone's job dictate whether they can afford their diabetes medications, prenatal care, or cancer screening? Although the push for universal health care is starting to divorce the two, the union is so prevalent and deeply ingrained that I don't think much will change. I understand the idea that employers and employees put their money in a pot and that businesses use their purchasing power with insurers, but adherence to these principles will lead to tragic cases like the one above.