The national conversation about the social safety net is in terrible shape, far behind where it was in the 1970s. There are of course sharp structural reasons for this, as the rise of the conservative movement and the reestablishment of corporate control over politics makes the passage of even basic legislation like keeping the government running is extremely contentious. That’s sad because in the 1970s, it seemed like we were about to make whole new leaps into a social safety net something like in western Europe. Today, we are just hoping to gain enough momentum to provide some fixes to the ACA, which while an improvement on the terrible state of health care in the United States, is a very flawed and limited program. A national child care program, the forgiveness of trillions in student debt, free public higher education, and other obviously beneficial programs are either not on the table today at all, only in the dreams of the liberal left, or just getting off the ground. Another of these is a vigorous national sick leave program. The Family and Medical Leave Act was a slight step forward, but any program that only provides unpaid leave is obviously quite flawed. Yet the costs of not having a real sick leave program are quite real.
Low-income mothers are particularly likely to work while sick. Another study, by LeaAnne DeRigne of Florida Atlantic University and colleagues, explains why. It found that families with less ability to afford unpaid time off are more likely to lack paid sick leave. According to the study, published in Health Affairs, 65 percent of families with incomes below $35,000 had no paid sick leave, while the same was true of only 25 percent of families with annual incomes above $100,000.
Paid sick leave slows the spread of disease. Cities and states that require employers to offer paid sick leave — Washington, D.C.; Seattle; New York City; and Philadelphia, as well as Connecticut, California, Massachusetts and Oregon — have fewer cases of seasonal flu than other comparable cities and states. Flu rates would fall 5 percent if paid sick leave were universal. According to one estimate, an additional seven million people contracted the H1N1 flu virus in 2009 because employees came to work while infected. The illnesses led to 1,500 additional deaths.
Paid sick leave has other benefits besides reducing flu deaths. For example, workers may use it for preventive care, forestalling subsequent, more disruptive health problems. Workers lacking paid sick leave are more likely to delay needed medical care, a finding that holds for both insured and uninsured workers. In other words, though health insurance helps people pay for health care, it does nothing to help them afford to take time off to get it.
Sicker workers may be more prone to job-related injuries. One study found that even within industries in which accidents and injuries are relatively more likely — like forestry, mining and construction — workers with paid sick leave experienced fewer of them than workers without it. Another study found that employees who work while sick are more likely to have heart attacks than those who take time off.
Unfortunately, like so much in the United States, the unwillingness of the government to provide social services means that risk gets placed on the individual, in this case disease spreading through society unnecessarily and at great cost.