Weekly Briefing

Here's a simple, common sense health reform that could be implemented right away

As has been reported in this space on many occasions, health care reform is coming. It's sure to take years to implement and be messy and imperfect and a long way from the complete package we need, but it's going to happen. Those who currently find themselves on the verge of pulling their hair out over the absurd and contradictory arguments of reform detractors should take a deep breath and resist the urge. If progressive forces keep working hard for the kinds of common sense reforms championed by experts at places like the Center on Budget and Policy Priorities and Community Catalyst, change will happen. The downsides of inaction are simply too great.  

Of course, even with real reform, there will still be much to do and no reason to delay action. National and state policymakers will still have a number of steps they can take right away to improve health outcomes and reduce societal costs that have nothing to do with assuring universal health care coverage or controlling price gouging by health insurers or pharmaceutical conglomerates.

Here's a classic example: paid sick days legislation. 

The need

As was reported in the New York Times this week, the ongoing H1N1 flu pandemic has highlighted a giant hole in way the United States responds to contagious diseases. This hole likely costs the country many, many innocent lives and billions of dollars in worker productivity. Here's how the Times put it:

"Public health experts worried about the spread of the H1N1 flu are raising concerns that workers who deal with the public, like waiters and child care employees, are jeopardizing others by reporting to work sick because they do not get paid for days they miss for illness.

Tens of millions of people, or about 40 percent of all private-sector workers, do not receive paid sick days, and as a result many of them cannot afford to stay home when they are ill. Even some companies that provide paid sick days have policies that make it difficult to call in sick, like giving demerits each time someone misses a day.

Public health experts say policies like these encourage many people with H1N1, commonly called swine flu, to report to work despite official warnings from the government and most companies that they should stay home.

‘For people who are really caught on a weekly income, if they can't make a go of it, they might say, "I'm desperate. I'm going to do what I have to do, and I'm going into work even though I'm sick,"' said Robert Blendon, a professor of health policy at Harvard.

He warned that this might spread disease, and that these financially squeezed workers might send their flu-stricken children to school, infecting others."

To those lucky enough to have decent jobs in modern and reasonably caring workplaces this may sound like something out of Dickens novel, but it's actually a remarkably common phenomenon. At least two out of five private sector American workers (and three out of four low wage workers) lack paid sick days. Of those groups, more than two-thirds told a recent national opinion survey that they had gone to work with a contagious illness.  

In other words, thousands upon thousands of Americans are likely to contract the flu in the coming months (and many people will die) for a very simple and preventable reason: thousands upon thousands of sick people will come to work because they can't afford to stay home and/or are afraid they'll be fired if they do.

And those job loss fears appear to be well-founded. The Times reports that, according to the same national survey, "11 percent of respondents said that they had lost a job for taking off for an illness for themselves or a family member, and 13 percent said they had been told they would be fired or suspended if they missed work because of personal or family illness."

This hesitance to stay home when sick carries over, of course, to schoolchildren as well; parents who lack paid leave to care for their kids send them to school sick - thus endangering other children and school personnel.  

Seeking a solution

The fix for this crazy situation is not that complicated: the United States simply must follow the lead of other advanced nations and enact policy solutions that encourage sick and contagious people to stay home from work and school. Unless people feel secure in the belief that they are not placing their economic future at risk by staying home, they will continue to endanger others.

Unfortunately, while many such proposals are in the legislative pipeline (North Carolina lawmakers introduced a pair of companion bills on the subject during the most recent session of the General Assembly and included language in the omnibus "studies" bill that will allow further consideration of the issue this fall and winter) such legislation will not be timely enough to address the current flu pandemic.

This week, in response to the rapid spread of H1N1, Congressman George Miller and Congresswoman Lynn Woolsey introduced a bill that just might help. The measure is entitled the "Emergency Influenza Containment Act" and it would guarantee a sick worker up to five paid sick leave days a year if an employer "directs" or "advises" a sick employee to stay home or go home. The bill would cover both full-time and part-time workers (the latter on a pro-rated basis) in businesses with 15 or more workers. Employers that already provide at least five days' paid sick leave would be exempt.

Under the bill, an employer would be able to end paid sick leave at any time by informing the employee that he or she (the employer) believes they're well enough to return to work - though employees would be able to continue on unpaid leave under the Family Medical Leave Act or other existing sick leave policies. Employees who follow their employer's direction to stay home because of contagious illness could not be fired, disciplined or made subject to retaliation for following directions. 

In the interest of speed, the bill would take effect 15 days after being signed into law. And in the interest of political pragmatism and compromise, it would "sunset" after two years unless Congress acted to affirmatively reauthorize it.

Going forward

The reaction of worker advocates to the Miller-Woolsey proposal was positive but somewhat muted. According to long-time paid sick day supporters at the National Partnership for Women and Families, the emergency legislation is a good start, but less than what is actually needed.

"The paid sick days law America needs will go further than this initial bill. It will allow workers, not employers, to decide when they are too sick to work-and are healthy enough to return to work. It will cover care giving, so parents can stay home with sick kids without risking their family's economic security. And it will provide job security for workers who are too sick to come to work."

While this reaction is understandable (and accurate), let's hope groups like the Partnership work hard to secure passage of some kind of emergency legislation. And let's also hope that business lobby groups like the Chamber of Commerce and the National Federation of Independent Businesses (a group whose website still advises members on how to dock employees for staying home sick!) come to their senses and get behind such legislation as well.

True health care reform may be a way down the road, but in the mean time, there's plenty of near term, common sense steps that we can take to save lives. Some version of paid sick days legislation is an obvious one.

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This entry was posted on Thursday, November 5th, 2009 at 11:12 am and is filed under Weekly Briefing. You can follow any responses to this entry through the RSS 2.0 feed.