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"stay Home...see A Doctor." But What If You Can't?

"If you're sick," government officials are saying, "stay home, get treatment, go see a doctor."

It's good advice, even when the swine flu isn't in circulation. But not everybody can follow the advice so easily.

If you read this blog, you already know that many millions of Americans don't go to the doctor because they can't pay their medical bills. What you may not know is that many millions of Americans don't take sick days, either, because their employers don't offer paid medical leave.

Research by the Urban Institute suggests that around half of all private sector workers don't have paid medical leave. Among people working in lower-wage positions, the proportion without paid medical leave is even higher: 76 percent, according to the Bureau of Labor Statistics.

Particularly for these people, who live paycheck to paycheck, taking a day off from work is no small matter. It means giving up a day's pay and, potentially, jeopardizing job security. Neither option is one to take lightly, particularly in this economy. (Indeed, in this economy, even middle-class people have to worry about such things.)

One hundred forty countries guarantee paid leave to all citizens. In fact, among the countries with the twenty largest economies, the U.S. is the only one that doesn't promise paid sick days. But there's a move afoot to change that. The Healthy Families Act, sponsored in the House by Rosa DeLauro and sponsored in the Senate by Ted Kennedy, would require companies with more than 15 employees to provide up to seven days of paid medical leave.

It's not a new idea. DeLauro and Kennedy first introduced the measure in 2005. New York Times columnist Bob Herbert wrote movingly about it here, back in 2007. But, despite strong public support, it hasn't become law. A big reason is opposition from the business community, which says such a law would impose an unfair financial burden on employers--particularly small employers--while disrupting productivity.

I haven't waded through the studies or the data either side is using to support its views. But, on its face, the argument opponents are making doesn't seem particularly persuasive.

Remember, the Act would exempt the smallest businesses and mandate just seven days of paid sick leave. Don't forget, too, that it can be even more costly for a company to have sick employees show up at work, where they can infect co-workers. 

Of course, sick workers can infect customers, too, which is why--even before the swine flu outbreak--paid medical leave was a legitimate public health issue. Among other things, it turns out that the proportion of food workers without paid medical leave is even higher than the proportion of low-income workers overall. And that's led to documented disease outbreaks, as one new study in California suggests:

New research findings show that paid sick days may help limit food-borne disease outbreaks thereby protecting the health of workers and individuals in the State of California. New evidence released today by the Human Impact Partners (HIP) and researchers at the San Francisco Department of Public Health (SFDPF) demonstrates that food handling by sick workers contributes to a substantial share of foodborne disease outbreaks in California. In one case, an employee with confirmed norovirus (stomach flu) illness was implicated in an outbreak of the disease at a restaurant and infected 80 people.

According to Dr. Rajiv Bhatia MD, MPH, Director of Environmental Health for the San Francisco Department of Public Health, Between 2003 and 2007, California had 67 reported food-borne disease outbreaks occurring in restaurants, schools, day care centers and hospitals that were traced back to an ill food service worker. These outbreaks were responsible for 1,955 cases of illness.

California legislators are looking at implementing their paid medical leave laws, as are lawmakers in several other states. DeLauro and Kennedy will be re-introducing their legislation shortly, in the hopes of delivering a bill to President Obama, who has indicated he'll sign it.

For more information, check out the National Partnership for Women and Famlies or

--Jonathan Cohn