Thread by @marklewismd

I'm an oncologist and a patient with cancer.

Surely now is the time in America to uncouple employment and healthcare coverage.

In fact, it's long overdue ...

THREAD
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For years now, cancer patients have faced double jeopardy: their malignancies have endangered their ability to carry out their pre-morbid jobs, and when they lose those benefits, their treatments become financially toxic, often to the point of bankruptcy.

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This is seldom a matter of just forsaking luxuries. I have seen patients struggle to pay their electric bill vs. obtain life-preserving medication.

Through twisted logic, they are sick enough to need treatment, but too sick to maintain the jobs that cover that treatment.

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And what about disability policies, you say? First of all, I spent HOURS a week completing paperwork, which does not always reasonably account for the unpredictable waxing & waning of energy & physical function during a longitudinal treatment course.

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Patients are held to an impossibly restrictive set of pre-specified parameters. 3 days after the operation to remove my pancreatic cancer I had a phone call asking me to estimate my return to work, telling me my short-term benefits would lapse if I took longer than 5 weeks.

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And I do know I am vastly more fortunate than the millions of Americans with fixed incomes living paycheck to paycheck, with a razor-thin margin for financially absorbing the slings & arrows of outrageous fortune: a fall, a car accident, and now #COVID19

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The #coronavirus and the attendant steps we need to take to #flattenthecurve are a nightmare for many in the service industry, many of whom rely on direct contact with the public for their very livelihood. Many of those same workers are under-insured for catastrophic illness.

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I know this country was built partly, or even largely, on a notion of rugged individualism, that hard work will reward those who persist in their vocation, and that they then are entitled to the better life they've earned through their labors.

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But a national crisis -- indeed, a global pandemic -- highlights our interconnectedness. The virus itself does not care about socioeconomic strata, and the affluent cannot simply isolate themselves like the aristocrats in the Masque of the Red Death.

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Blunting the death toll from #COVID19 in the United States will take a united effort, and there is a real risk that patients will die because they cannot afford treatment (or even testing!). Rich or poor, Democrat or Republican, we can only get through this together.

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I am no economist but I believe I am "staying in my lane" when I care about the health of my patients, many of whom were already living close to financial ruin and now have additional worries about dwindling income & securing childcare during school closures.

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That this outbreak is happening in an election year at first seems like a sick cosmic joke. In our already riven nation, it is tragic that we would politicize our response to a threat that could hardly be more non-partisan.

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But we may also now have the opportunity to realize, together, the self-defeating linkage of our jobs to our ability to remain healthy.

We should not compound the miseries of illness with the all-too-real risk of poverty, which can establish a quite literal death spiral.

fin/

*spend