Errors like straws upon the surface flow
He who would search for pearls must dive below.
 All for Love, prologue (1678), by John Dryden (19 August 1631 – 12 May 1700)

Dryden could have been advising modern day humanity, especially the American variety. Here in the 21st century, with news cycles of about a minute and a half, many flimsy, insubstantial, error-filled straws float on the surface, and few of us get to see the pearls lying deep below. We no longer seem to have the time or the means to look deeply at anything.

Take sick leave, for example. Seems a simple concept. You get sick, you stay home from work to heal yourself and not contaminate others. Our  long COVID nightmare testifies to that. But if you do stay out of work to heal yourself, do you lose your job if you’re out too long? And what about money? Where do you get it? Are you one of those fortunate few whose employers provide paid sick leave? Or any sick leave?

You might be if you live in one of the sixteen states that mandate paid sick leave, or one of the four states in which some cities do the same. Or you may work in the public sector for the federal government, or for a state, or city, or town, or county, where paid sick leave, mostly negotiated by unions, has become the norm.

The most basic question, of course, is this: Does your employer even allow you to keep your job if you call in sick? In many states if you work for a company with fewer than 50 employees, there is no requirement for that. According to the Department of Labor:

Currently, there are no federal legal requirements for paid sick leave. For companies subject to the Family and Medical Leave Act (FMLA), the Act does require unpaid sick leave. FMLA provides for up to 12 weeks of unpaid leave for certain medical situations for either the employee or a member of the employee’s immediate family. In many instances paid leave may be substituted for unpaid FMLA leave.

Employees are eligible to take FMLA leave if they have worked for their employer for at least 12 months, and have worked for at least 1,250 hours over the previous 12 months, and work at a location where at least 50 employees are employed by the employer within 75 miles.

Sick leave, even unpaid and even if covered by the FLMA, comes with catches.

Sick leave in America, like so many other things, is an Irish stew thrown together by the individual states. The Society for Human Resource Management (SHRM) has a good state-by-state summary, but why should this be necessary? If a worker deserves sick leave, either paid or unpaid, in one state, why shouldn’t another worker in a different state deserve the same?

Consider my home state, the Commonwealth of Massachusetts, where, since 2015, most workers have the right to earn and use up to 40 hours of job-protected sick time per year to take care of themselves and certain family members. Workers must earn at least one hour of earned sick leave for every 30 hours worked.

Although many will suffer their hair igniting when they read this, it’s better in the European Union, where all workers, regardless of where they work, or for whom, have a form of paid sick leave. According to the EU’s Sick pay and sickness benefit schemes in the European Union: 

A sickness benefit is provided by the social protection system and is paid as a fixed rate of previous earnings, or a flat-rate amount. All European Union (EU) Member States provide sick leave and sickness benefits.

But we live in America, where sick leave is a crap shoot at best. Can we take a minute to dive deeper and find a pearl or two below the surface?

There are numerous studies on the benefits of paid sick leave, these include lessening healthcare financial burdens, preventing the spread of illnesses (including COVID), increasing the use of preventive health care services, and reducing on-the-job injuries.

Now, University professors Yanlei Ma, Kenton J. Johnston, Hao Yu, J. Frank Wharam, and Hefei Wen have published a study in Health Affairs examining the economic benefits of paid sick leave through the lens of Emergency Department (ED) visits. Their conclusion?

We found that state implementation of paid sick leave mandates was associated with a 5.6 percent reduction in the total ED visit rate relative to the baseline, equivalent to 23 fewer visits per 1,000 population per year.

The point these latest researchers make is when people do not have a sick leave benefit they remain in the workplace practicing “presenteeism,” that is, being at work when they are not healthy (and probably less productive). Then, when their condition becomes worse they end up in the the most expensive health care setting in the world, their local Emergency Room.

The US stands out among other wealthy democracies for lacking nationally mandated paid sick leave. According to Ma, et al, this leaves 23 percent of the nation’s workforce without a single paid sick day.

Opponents of mandated paid sick time say most employers already provide paid sick leave, so mandating it is unnecessary. Tell that to the 23% without any.

Right now, given our polarized government, I don’t have great hope we’ll be seeing universal paid sick leave anytime soon. As an example, in 2018, Texas became one of those four states I cited above where three individual cities, Austin, Dallas and San Antonino, passed local paid sick leave mandates. In 2020, the Texas Supreme Court affirmed a state Appellate Court’s decision the mandates were unconstitutional. Now, regardless of where you live in Texas, although many employers offer a sick leave benefit, paid sick leave is not mandatory anywhere.

It seems to me this is really a question of equality. And for now, some workers are a lot less equal than others.