Contagion Nation
26 May, 2009
By Jerry E. Stephens
An Unintended Consequence of Our Nation’s Health Care-Related Policies?
Photo by Michal Zacharzewski
The recent worldwide outbreak of the A(H1N1) influenza virus affected many. Schools closed. Attendance at public gatherings was greatly reduced. The economic impact caused by the fear of a pandemic was felt in many countries, even those with few influenza sufferers. Mexico, which many believe may have been the site of the initial outbreaks of influenza, suffered dramatic declines in tourism leaving a national economy in serious distress.
The United States may have been affected to a degree not yet fully appreciated here. The World Health Organization has listed more cases of A(H1N1) in the United States than any other nation. [1] But only a handful of cases resulted in death to the infected. The economic impact seems to have been almost minimal.
The influenza outbreak in this country may, however, have exposed an entirely unanticipated but serious health-related issue. The exposed issue results directly from the distortions in our many, varied, and often conflicting national health care policies.
Do American employers provide sufficient sick leave for their employees? Does the absence of sufficient employee sick leave benefits leave this nation more susceptible to the spread of disease through our work places?
Are we an unhealthy nation, or as the authors of a new national study term it, a contagion nation? [2] Are we an unhealthy nation because of the unintended consequences of our national sick leave policies or even the absence of such policies?
What are “unintended consequences?” One online encyclopedia article writes of them this way: “any purposeful action will produce some unintended consequences.” [3] Another way of looking at them is as “unforeseen consequences” of some action. Steven Gillon writes of them as “one of the most immutable rules of nature.” [4] Gillon calls them the “contradiction between intention and result.” [5]
The failure to provide adequate employee sick leave benefits should now be seen as one such unintended consequence of national policymaking. A new study from the Center for Economic and Policy Research, a Washington, D.C. institution promoting democratic debate on economic and social issues, concludes that the absence of adequate employee sick leave benefits leaves Americans more susceptible to the spread of diseases such as caused by the recent influenza outbreak.
The report reviews two types of sick leave benefits provided to many employees: paid sick-days and longer term paid sick-leave. The national policies of 22 different countries, mostly in Europe but including Australia, Canada, Japan, New Zealand, and the United States, are compared.
One finding jumps out immediately. The United States is the only one of these “rich” countries that “fails to guarantee sick workers some form of paid sick leave.” [6] As the authors of the study observe:
Current U.S. labor law does not require employers to provide short-term paid sick days or longer-term paid sick leave; current U.S. law does not even protect all workers from being fired when they miss work due to illness. [7]The United States certainly does have something of a national health-related sick leave policy in place. The Family and Medical Leave Act [8] enacted in 1993 requires employers to provide qualified employees with job-protected but unpaid leave under certain more limited circumstances. An eligible employee may use such unpaid sick leave to care for members of the immediate family (parents, spouse, or children), for pregnancy or when a “serious health condition” has arisen.
Should we be concerned about the possible unintended consequences of our nation’s views on employee sick leave? The authors of the CEPR study certainly believe we should be concerned:
Provision of paid sick days or leave is critical to the ability of employed Americans to take time when they or their family members are sick and to prevent the spread of influenza and other contagious diseases. Paid sick days and leave are essential for ensuring that all Americans can treat and address their own and their family members’ serious diseases. A substan- tial body of research has shown that in addition to the obvious health and economic costs imposed on employees by the lack of paid sick days or leave, significant economic costs result as well for employers. Workers who go to work while sick stay sick longer, lower their productivity as well as that of their coworkers, and can spread their diseases to coworkers and customers. [9] (emphasis added)American employees often go to work sick. And then infect their co-workers. Or their children go to school sick because the parent feels compelled to return to work instead of using the available but unpaid sick leave from their employer.
There is a better way:
Everyone is vulnerable to illness and injury. Unlike the rest of the world’s rich economies, the United States relies on voluntary employer policies to provide paid sick days to employees with short-term illnesses. As a result, at least 40 percent of the private-sector workforce in the United States does not have paid sick days or leave.The reader who wants to understand why the possibility of unintended consequences is a serious matter should study Steven Gillon’s book, That’s Not What We Meant to Do. Gillon, a professor of history at the University of Oklahoma, examines the impact of the enactment of national policies in the areas of welfare, mental health, civil rights, immigration, and election campaign finance and the consequences that followed from such enactment. He catalogs a number of such unintended consequences. He particularly observes that “the failure to obtain sufficient information about possible outcomes” is a major contributor. When there are such unintended or unforeseen consequences, Gillon writes that “we must look again at the maps and charts with fresh eyes and try to plot better and wiser courses.” [11] (emphasis added)The rest of the world’s rich economies have taken a legislative approach to ensuring paid sick days or paid sick leave. Of the 22 rich countries whose labor law we analyze here, all but the United States guarantees some form of paid time off tied specifically to illness. The United States is the only rich country in the world that does not mandate any form of paid sick days or leave.... Always critical, addressing the policy gap is more urgent in the current economic downturn. [10]
Understanding the place and impact of employer-provided sick leave benefits is one such matter that really does need fresh eyes as we prepare for may be a more virulent outbreak of influenza or other disease in the future.
Sources:
- World Health Organization. Influenza A(H1N1) – update 33. Available at
http://www.who.int/csr/don/2009-05-19/en/index. The latest report finds the occurrence of 5,123 cases in the United States; and 3,648 cases in Mexico. A total of 9,830 cases have identified in the entire world as of May 19, 2009.
- Jody Heymann et al. Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries. Washington, DC: Center for Economic and Policy Research, 2009. The study is available online at http://www.cepr.net/documents/publications/paid-sick-days-2009-05.pdf
- “Unintended Consequences.” Wikipedia. http://en.wikipedia.org/wiki/Unintended_consequence (last visited May 18, 2009)
- Steven M. Gillon. “That’s Not What We Meant to Do”: Reform and Its Unintended Consequences in Twentieth-Century America. New York: W.W. Norton & Co., 2000. p.17.
- Id.
- Heyman et al. Contagion Nation. p.1 and Table 1, p.6.
- Id.
- Public Law 103-3, 103rd Cong., 1st sess. (Feb. 5, 1993); U.S. Code ti.29, secs. 2601 et seq.
- Id. note 2 at p.1.
- Id. note 2 at p.16.
- Id. note 4 at p.240
© 2009 Jerry E. Stephens
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Email: jstephens6@cox.net
