I have to get back to work. These are words not infrequently heard among my hospitalized patients. Many tell me they fear losing their jobs if they are absent from work too much. These patients are willing to cut their hospitalization short for the sake of staying employed…and insured. Because "the job" provides this health insurance, patients are forgoing urgent medical treatments to preserve access to future medical treatments. I believe it is time to address this absurdity and replace employer-provided health insurance with a delivery system void of employers.
My last patient requesting to go home early was Jack (whose name has been changed for privacy reasons). He had an organ transplant that required medications to sustain its function but also increased his risk of serious infections. With high fevers, he was instructed to go to the hospital to be evaluated. When I met him, he felt good and not particularly ill. He wanted to go home before completing his infectious evaluation and promised to return to the hospital if he felt worse.
I asked Jack why he needed to go home so soon. He shared his concern about losing his job and the health insurance that came with it. Despite the fevers and potentially dangerous infection, Jack was determined to get home to keep working. He told me that staying employed would secure ongoing health insurance coverage and access to the critical drugs and physicians needed to care for his precious organ transplant.
It's ironic, yet completely rational, that Jack was willing to risk his current health to secure his well-being in the future. Having health insurance not only facilitates health care access, but also financial stability. Medical bills are cited as the leading cause of bankruptcy. With the expansion of health insurance coverage, the rate at which individuals filed for bankruptcy declined by approximately 50%. Between the protection against catastrophic health care costs and the provision of income, "the job" has been, and continues to be, crucial to preserving physical and fiscal health.
The issue lies in the fact that nearly 60% of individuals under the age of 65 obtain health insurance through their employer. This arrangement creates a number of unnecessary conflicts. This system lacks portability of health insurance, potentially tethering an individual to a particular job for its health benefits. That dependency on job-related health benefits then juxtaposes the need for medical attention with preserving employment. As a result, some individuals may make sacrifices in caring for themselves to safeguard their jobs, health insurance, and income.
The solution to this dilemma is the removal of employers from the equation. Despite the employer mandate, the Affordable Care Act (ACA) makes an important first step toward this goal through the health insurances exchanges, also known as the individual marketplace. In these health exchanges, individuals can directly purchase affordable health insurance independent of employment.
As the health care debate continues, I believe we should continue to support and expand the health insurance exchanges or make the move towards a single-payer system. Both options ensure health insurance coverage without the added pressure of returning to work prematurely. In doing so, patients, like Jack and many others, will not have to sacrificially choose between a treatment and employment.
James D. Park, MD, MPH, MSHP is a hospitalist physician at the Hospital of the University of Pennsylvania and an Assistant Professor of Clinical Medicine in the Section of Hospital Medicine.