But What If You Can't Afford To Stay Home?

What's a good citizen to do if he or she thinks that cough and sneeze is swine flu? The Centers for Disease Control and Prevention recommends:

Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

This afternoon I've been reading Nickel and Dimed: On Not Getting By in America by Barbara Ehrenreich - which is ever so more relevant now, if that were possible, than when it was originally released. Near the end she notes:

It is common, among the nonpoor, to think of poverty as a sustainable condition - austere, perhaps, but they get by somehow, don't they? They are "always with us." What is harder for the nonpoor to see is poverty as acute distress: The lunch that consists of Doritos or hot dog rolls, leading to faintness before the end of the shift. The "home" that is also a car or a van. The illness or injury that must be "worked through" with gritted teeth, because there's no sick pay or health insurance and the loss of one day's pay will mean no groceries for the next. These experiences are not part of a sustainable lifestyle, even a lifestyle of chronic deprivation and relentless low-level punishment. They are, by almost any standard of subsistence, emergency situations. And that is how we should see the poverty of so many millions of low-wage Americans - as a state of emergency.

One simply can't choose to stay home from work under those conditions. In an Afterword written in late 2007, Ehrenreich writes that an Economic Policy Institute report found

an astounding 29 percent of American families living in what could be more reasonably defined as poverty [as compared to the more stringent federal poverty line definition]. At least this was the percentage of families earning less than a bare-bones budget covering housing, child-care, health care, food, transportation, and taxes - though not, it should be noted, any entertainment, meals out, cable TV, Internet service, vacations, or holiday gifts. Twenty-nine percent is a minority, but not a reassuringly small one, and other studies have since come up with similar figures.

Can we reasonably expect people living in such conditions to stay home from work while sick - plus two days after symptoms have subsided, as I heard recommended for students at the University of Delaware - when they have no sick pay, no resources to fall back on, and in some cases, not even any real home to stay in while away from work? In some cases, as Ehrenreich observes in her book, work may be the source of one of their free or deeply subsidized meals.

I do not think this bodes well for us as a nation in dealing with a potential pandemic.

Just one more reason why the strategy of short-term gains in the bottom line from keeping workers' wages and benefits down is not a viable long-term strategy for a healthy economy or society.

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One more reason why perhaps the single most important thing the Obama administration can do for America is to dismantle the protection racket that Americans have been conned into calling "health insurance".

I once worked for almost three weeks with a low grade pneumonia. Finally went to the ER when I passed out (mind you, I had already managed to pass it back to my eldest, who was the source of mine) and was told that I had to rest for at least four days, preferably a week - or I would get sick again, antibiotics or not. Rent was late the following month ($75 late fee) and I managed a meal every other day because I have wonderful friends (did keep eldest fed).

I love these motherfuckers who whine about UHC and claim that it's the fault of poor fuckers that they can't afford healthcare. I like to ask them if they think the poor asshole who makes their lunch can afford to take time off work because s/he's sick.

Time off for illness or injury is a fucking luxury that only goes to those who can afford it, or those who can't manage to stand without vomiting. The latter is likely to go hungry/ier if that happens to them.

And Fort Worth has closed schools until May 11th. I wouldn't be surprised if that happened in many other urban areas, deemed high risk or not.

This is done, of course, with no thought to the effect it might have on single parents or those struggling to get by even on two incomes; parents faced with the choice of having enough money to just feed the kids, let alone pay for medicine, or staying home to care for them.

But then, anything public school systems do usually elicits a *headdesk* from me.

Great book, one that everyone should read.

I think the "stay home" idea is good in principle, but I agree with bill- without national health insurance, it makes no sense to act like that's going to fix anything.

There are, however, a lot of people who can afford to stay home and don't, just because they're overambitious/competitive/selfish. We have way too many of these jerks who should know better working in academia/science.

I think we should do like Japan does, and have the sick people wear masks. You can come to work if you're sick, but you have to wear a mask. Beyond that, I don't have any great ideas. Cooperative babysitting with your neighbors and coworkers, I guess might be your only option if you don't have relatives nearby to help in cases like these.

Add to this the fact that most of the working poor/poverty-stricken work in...wait for it...food service and cleaning. Do you really want someone with the flu preparing your burger or cleaning your hotel room? The folks who can afford to stay home are often those who are least likely to transmit their illness--people who work in offices, but don't come into contact with large numbers of people every day.

That is such a great book. I am amazed at how often I refer to ideas from this book in the years since I've read it. Also, I don't usually remember details about books but Nickel & Dimed have burned themselves in my brain.

It's also a reminder of how fortunate I am. I have a job with paid sick leave. I have a nanny who can watch my children if the school closes down for a swine flu outbreak. I have family and friends that will ensure my kids and I have a roof over our heads and enough food to eat.

Great post Zuska. I also recoiled at the "stay home" recommendation issued as if that were an option for everyone (or that those for whom it is not somehow are invisible). It makes me feel incredibly fortunate to have that option. And yes, people who cannot afford to do so are frequently those who have the most chance of spreading something like the flu to a greater number of people via their jobs. Our healthcare system is broken - it's true. But so is our support system for the impoverished. This extends far beyond healthcare.

My institution has temporarily lifted their ban on bringing kids to work in light of recent school closures. This is really commendable from the perspective of helping their employees out with childcare. However, a better solution would be to let their employees go home rather than bringing their potentially exposed kids to a place where they could infect already compromised hospital patients.

Someone pointed out on NPR this morning that our frontline of defense is primary care physicians. It is they who are identifying cases, contacting the CDC, and treating the infected. If I remember correctly, this comentator stated that some 45 million people don't have a PCP. Those cases will not get identified unless the person gets so sick that they end up in an ER or other emergency clinic.

THAT'S what they should do with the goddamn money they're putting up for this thing! Use it to fund sick pay for people who don't have the ability to stay home from work!

Fuck, but that would make too much sense.

Great post!
I had to stay home last week (gave up a 10 hour shift at work) because I had a migraine (was throwing up and blacking out). It cost me $150. That $150 would have been my groceries, phone bill, living expenses for the 7 day period. I am at uni studying a full time course load and I also do volunteer work, so I only work 15 hours a week. This week, because of my sickness, I will subsequently only earn $70. I feel incredibly nervous and ill thinking about it.

I live in Australia, and a few years back we had a government that brought in an industrial relations regime that will leave scars for years to come. They scrapped things like penalty rates, sick leave, protection against unfair dismissal for a lot of workers. Because of these laws, I do not receive penalty rates, and it is legal for my employer to do this. We got a new government in 2007, though relics of the previous government's laws won't be fully phased out until 2013. It is scary stuff.

I agree that casual workers ( especially students, low income earners etc.) have no support, and it really baffles me that government authorities can say things like, "Well just stay home until you feel better". Where does this kind of ignorance come from???

This is a great post. In a study by three Harvard medical scientists, researchers found that Americans are less healthy than Canadians and have poorer and less accessible healthcare yet spend twice as much on it per capita. This same study showed that Americans suffered more from chronic illnesses and obesity than Canadians. The cause of this was as many of your readers have identified, the American healthcare system. The crux of the problem is the middleman - ie insurance companies. Get rid of them and you'll get rid of the incredibly high cost of health care. One of the authors of the study, David Himmelstein, said that in Canada administrative costs accounted for one cent of every dollar spent on healthcare, but in the US it was 15 cents for every dollar.

re. insurance. add to the points you make in your post the fact that there's a conflict of interest built into health insurance in the U.S.: health insurance companies want us to die outright, rather than linger. they even want us to die outright rather than be sick for a long time and then *get well*. if we've been sick once, we'll probably get sick again sometime, after all.

because only the employed are insured (of *cooooourse* the families of the employed are also insured. until 'the employed' ceases to be employed). since the insured represent essentially 'the set containing the full-time employed staff of companies with n or more employees', insurance companies don't lose customers when their insureds die. because that person will be replaced -- ostensibly with someone healthy. health insurance companies won't have a stake in people's health until death really starts costing them. as in, when someone dies, it really is one less payment into their coffers. maybe now that the economy's bad, and there are many hiring freezes in place, insurance companies will care a little more for a little while. but i doubt health insurance company culture has really figured this out. insurance company staff are too busy looking over their *own* shoulders trying not to get rif'd.

The policies are, obviously, formulated by people who are in no danger of missing a meal unless they want to. People who have no life experience of "if I don't go to work, I don't eat, and I may not make rent again this month as it is." And having never experienced this, it isn't "real" to them. Which becomes blindingly obvious to all those who HAVE had some experience of it.

Back in my bad old days, there were a number of months where "lunch" was sugar cubes I stole out of the coffee room. And there was the job I eventually lost, because I had an untreated infection (no health insurance and, as a clueless 19-year-old, no real idea of the fact that I could go to the ER for this) and finally, one morning, literally couldn't make it out the door. I did end up getting treatment (a more clued-up friend dragged me to Emergency), but I was off work for more than 5 days -- and the business I worked for just wouldn't put up with my lack of dedication to the job and that was that, no final paycheck even (and I was too ill to fight them for it). I break out in a cold sweat at the thought of how many people are still trapped in situations like that. It is simply monumentally wrong.

And no, of course they aren't going to stay home if they have the flu.

By Luna_the_cat (not verified) on 08 May 2009 #permalink

There is an article in the Journal of Epidemiology and Community Health 2009;63:397-402; doi:10.1136/jech.2008.078238
that speaks directly to the topic of this post. "Sick at workâa risk factor for long-term sickness absence at a later date?" I can't access the article, but according to a blurb in a recent issue of the Philadelphia Inquirer about the article,

Workers who came in while sick at least six times a year were 54 percent more likely to subsequently lose at least two weeks of work to illness, and 74 percent more likely to lose more than a month...Of course, it could just be that the sickest people are more likely to take sick leave and work while sick. But the researchers...say they corrected for overall health and previous long sick leaves. They suggest that short periods off sick may allow workers to cope better with the stresses of a demanding job.