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Lack of Sick Leave is Unsurprisingly Bad for Employee Health

A recently published poll, a joint effort between NPR, the Robert Wood Johnson Foundation, and Harvard's T.H. Chan School of Public Health, shows how difficult it can be for working people to get treatment for health problems.

Chief among the problems shown in the study is a lack of health related leave time.

While the Affordable Care Act, among other efforts, reduced the percentage of uninsured adults to 10.4% (as of the 2014 census), many insured workers have a hard time receiving the care they know pay for.

And patients with chronic illnesses, those conditions which persist and must be treated over time, face the most problems. Alison Kodjak of NPR explains it this way.

"You go to your doctor's office, then have to run across town to a lab for a blood test and then you also have to get an appointment for an X-ray or MRI. There's a good chance this will all require a phone call — or a lot of phones calls — with your insurance company."

The healthcare system that we have in this country, while better than many, isn't setup to handle the type of chronic illnesses that are more common now than when it was first instituted.

In short, this system is more effective at handling acute medical conditions—broken bones, infections, heart attacks— those that respond well to a short course of treatment— than chronic problems.

But chronic medical conditions are much more common now than before, and are of much greater concern to working people, particularly as they age —diabetes, arthritis, cancer— these are what today's employees has to worry about, and treating them is expensive.

Chronic medical conditions can be difficult to diagnose, and may need input from different specialists and a battery of tests. Once they are diagnosed, they may require a lifetime of treatment.

Cancer, quite famously and tragically, is never cured, it goes into remission. Likewise many people are able to manage diabetes with diet and blood sugar monitoring, but it never goes away, it takes a lifetime of checkups and prevention.

That means lots of trips to the doctor, lots of tests and seeing specialists over the course of one's life. Kodjak likens it to a full or part time job for these patients.

Now imagine trying to work a regular job and living with one of these illnesses.

The problems for working people will likely be familiar to you. Getting in to see a doctor, or trying to get a diagnosis, is an adventure you'd rather avoid.

For one, finding a provider that works within your network is never easy nor intuitive. Even with help from the internet, it requires a game of phone tag that can take days. It's not just that you need time off for an appointment or procedure. It's also that prep time can quickly eclipse the time it takes to receive care.

And if you need blood work, lab tests, to see a specialist, or a second opinion, your problems (and costs) will compound.

All this points to the same conclusion that we've been talking about for years. Americans aren't getting access to preventative care and it's making them sicker. And this study shows why.

32% of those participating in the study (all working adults) reported they don't receive paid sick leave. 24% responded that they don't get any paid vacation.

This means there's no time during the workweek (y'know, when doctor's offices are open) to get in for a checkup. And the companies we work for aren't doing their part for employee health.

When you're a wage worker with no PTO, getting in to see a doctor (if and when you can) comes at the high cost of missing work. And missing work means missing pay, even for a routine checkup.

Salaried employees have it little better, although they usually get to keep their money. But there's still a constant pressure to appear hardworking. Even though there's no positive correlation between long working hours and increased productivity, white collar jobs come with the pressure to work 60–70 hour workweeks.

When an employee, salaried or otherwise, takes time off for health reasons it is always a gamble. There's a threat that taking any time off will label you a slacker and a liability.

While it's against the law to terminate an employee for their medical history, there are still ways to fire sick people without repercussions. At-will employment, for instance, often provides the excuse to terminate sick and disabled employees that are seen as a burden.

[ed: We will remind you that terminating an employee for their medical history violates California's Fair Employment and Housing ACt.]

Even though laws exist to aid the sick and disabled, the responsibility to enforce those laws often enough lies with the plaintiff. The burden is usually on the victims of this kind of discrimination to file a complaint or seek out a lawyer.

Many companies have substantial enough legal and HR depts. to give employers a feeling of invulnerability when it comes to firing sick and disabled workers. And, crucially, most people would rather take the hit and look for a new job than go through litigation.

With loss of income, discrimination, and the threat of termination standing between workers and their healthcare, it's no wonder the CDC estimates that among the top five causes of death, 20%–40% of fatalities were preventable.

But what comes next may be the most tragic thing of all.

This very same study, that seems to show employers negligently standing between workers and health, reports 89% of respondents say their workplace is very or somewhat supportive of the steps they take to improve their health.

So, evidently, when it comes to eating vegetables and losing weight, the company is on board, but when it comes to ponying up some cash for employee health, this "support" is nowhere to be found.

And this lip service to a healthy lifestyle has been enough to fool employees into thinking the bosses have their health interests in mind.

But it's not just our decrepit, jerry-rigged healthcare system causing the problem; it's the fault of greedy employers who use every opportunity to save short term money.

The great irony is that insurers and employers alike neither seem to care nor understand that preventive care is proven to lower costs. A little preventive care, including some regular doctor visits, goes a long way in reducing the burden on the entire system.

It seems that, as always, the only way to get private companies to do the right thing (even when it's the cheapest thing) is to force them. So to this end, the state of California began mandating paid sick leave for all regular workers. (the law stipulates you must work more than 30 days per year in CA to accrue sick leave.)

Effective July 13th 2015, California instituted a policy wherein employees earn 1 hour of sick leave for every 30 hours worked. (The 30:1 rule) Or employees can access 3 paid sick days starting with the beginning of the working year. (The up front rule)

This isn't much, but it's a start. And it's a far cry better than what you'll get in many other states. Hopefully, once companies start seeing the benefits of sick leave, in having healthier and more productive employees, they'll start to be more accommodating of employees with chronic illnesses.

But, of course, only half the problem lies on the employer side, the rest lies with insurers and providers to find ways to better serve the sick and disabled. Until then, the burden lies with the victims to lawyer up and demand what they're owed.


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