27 April 2009

By Dave Lindorff

The outbreak of a new swine flu in Mexico, and the potential threat of a new global pandemic, shines a bright light on a major weakness in the United States—an employment system where most workers are not paid or even face getting let go if they get sick and have to stay home from work, combined with a broken healthcare system where roughly one in six persons has no ready access to a doctor.

What the American failure to mandate employer-paid sick-days means is that most Americans who don’t feel well go to work anyway, in part for fear of losing their jobs, and in part because they are already living so close to the margin that they cannot afford to miss a few days’ pay.

The result of this is that offices, buses, subway cars and elevators in coming weeks will be full of highly infectious people who really should be home trying to recuperate. So even if your employer does offer you sick leave, you will be placed at risk by other employers who do not offer that benefit to their workers, or even by lower-status workers at your own company who don’t get the same sick-pay benefits you do. (At Temple University where my wife works, it was only recently, after a long struggle backed by student activists, that contractor-service guards on the campus received sick pay. Before that, they had to come to work, sick or not, putting students and faculty at risk of infection.)

Add to this the fact that nearly 50 million Americans earn too much to qualify for Medicaid, yet work for employers who don’t provide them with any health insurance. For such people, going to a doctor is a serious problem. They probably don’t have the $50-$100 in cash to pay for an office visit—much less the $200-400 it would cost to bring all four members of a family—and going to an emergency room at a local hospital and asking for charity care for something like flu symptoms could mean a half day in a waiting room (with a lot of other sick people!). Not to mention that many hospitals cheat on their free care provision mandate and then dun patients for $2000 for seeing a nurse-practitioner and getting the advice to take two aspirins and drink a lot of fluid. And then of course, there’s coming up with the money to buy a costly drug like Tamiflu.

Who’s likely to do any of that without health insurance?

And so, as this latest round of flu starts to spread inexorably northward from Mexico, we can expect to see it sweep through our workplaces, and on into our schools, causing misery and no doubt a large number of deaths that never should have happened.

The joke here, though it is hardly funny, is that businesses will end up suffering as their workforces are sidelined for weeks, and as the larger economy, already in a deep recession, suffers a further blow. Sick workers don’t earn money, and thus have less to spend, and besides, when whole families are laid up and feeling miserable, they are not likely to go out on shopping sprees even if they do have money in their pockets.

It doesn’t have to be like this. An enlightened country would mandate that all employers offer their employees a minimum of one week’s paid sick leave per year, so that people could stay home if they came down with something. This benefit could be made cumulative, so that a worker would be incentivized not to abuse the benefit, and could use it in the event of a longer illness or injury.

An enlightened country would also see the self-interest for all in having a health system that provided care for all. It’s not just a matter of human decency, though one would hope that would be enough. It’s also in our own interest that the person who sits next to us in the office or on the bus have health insurance and ready access to a doctor when needed.

At a bare minimum, the federal government should set up free neighborhood clinics able to provide primary health care in every community where it is determined that there is a lack off access to physicians.

While we’re at it, school systems should also not be penalized if students miss days at school because of illness. At present, having students stay home for medical reasons reduces a school’s federal funding, as grants are based upon a formula that counts student days per year. This formulaic approach may lead school administrators to avoid calling for school cancellations at a time of a possible epidemic.

Hopefully this outbreak of swine flu will turn out to be nothing serious. But it should nonetheless serve as a wake-up call to the American public. The next crisis could be a serious outbreak of human-to-human bird flu, or a dramatic increase in drug-resistant Tuberculosis or who knows what other communicable disease.

And when it comes to communicable diseases, we had better accept that we have to be our brothers’ keepers or we will become their vectors instead.