The lack of structured paid sick leave policies in the United States leads to a dangerous underbelly of illness, infection, and poverty.
When only the privileged can afford to be sick, disease spreads, productivity decreases, and the overall wellness of our nation suffers.
And that’s exactly what’s happening.
Being Sick is a Privilege
Being sick is miserable. You’re tired and can’t focus. Depending on the illness, you’re either snotty or dealing with horrible stomach pains, coughing your lungs up or struggling to speak through a sore throat.
You just want to stay home in bed with a bowl of soup and sleep it off.
Millions of Americans can’t do that, and it costs us all.
How is Being Sick a Privilege?
In America, staying home when sick is a privilege, not a right.
Those who have it can leave work without question and stay home for a few days without any pushback from their bosses. If the illness doesn’t subside in a few days, they can visit an Urgent Care without worrying about the bill, as their employee-sponsored health insurance covers the cost. During the visit, they can snag the required doctor’s note excusing them from work for however long it takes to recover.
Privileged workers with paid sick leave and health insurance don’t have to stress about missing a paycheck, affording a doctor’s visit, or losing their job if they’re too sick to work. They can take time to rest and focus on getting better.
Unfortunately, too many people don’t have those luxuries. In America, being sick is a privilege that millions of citizens can’t afford.
The double whammy of no sick leave policies coupled with a lack of universal healthcare keeps us sick and helps infection spread.
America’s Paid Sick Leave Policies
The United States is one of only two countries among the 34 members of the Organization for Economic Cooperation and Development (OECD) that do not have mandated paid time off.
Despite the lack of legal mandate, many companies offer paid time off as a benefit to recruit top talent. These top-tier workers also tend to receive livable salaries, paid vacation time, health insurance, and other benefits commonly associated with a great work-life balance.
Unfortunately, a large portion of American workers don’t have access to any of these benefits. According to the Bureau of Labor Statistics, although 86% of all Americans have access to paid sick leave, only 57% of the workers in the bottom 25th percentile of wages get this benefit.
The number drops to 40% at the bottom 10th percentile.
But these statistics don’t tell the whole story. Even people who have sick leave typically don’t have enough. On average, employees with less than twenty years of service receive seven paid sick days per year, while those with twenty or more years get eight.
Those days go quickly with just one bad cold or flu, leaving limited time for doctor’s and dentist’s visits and preventive healthcare throughout the year.
Flexible Leave Policies Can Help or Hinder
Some companies limit their employees’ time off by offering either a combined paid time off (PTO) policy or a flexible time off (FTO) policy. PTO policies combine all leave types into one pool, while FTOs give employees unlimited leave to use as they see fit.
Companies use flexibility when describing their leave policies, so different industries may have a different vocabulary, but these are the definitions we will use for the sake of this article.
Though they seem like good policies on the surface, some companies use the language to take advantage of employees or prevent them from taking time off while reporting that employees have paid vacation time and paid sick leave.
Paid Time Off Policy
With a PTO, a company offers a set amount of paid time off per year, say ten days. You can use that paid time off for whatever you want.
So, you plan a two-week vacation to see your family for the holidays, but then you get the flu. Now you don’t have enough paid time off to cover both.
What do you do?
The Labor Department doesn’t compile statistics on whether companies offering flexible paid time off provide enough leave to cover vacations and sick time. According to a survey reported by The Balance, employees earn PTO benefits based on their tenure. Employees with less than five years of service get between 17 and 20 days per year, while employees over 20 can accrue up to 29.
Usually, these workers have enough paid time off for one two-week vacation per year, one week-long illness, and a handful of days off throughout the year.
Flexible Time Off Policy
Flexible time off policies are wonderful benefits for employees, in theory. Imagine not having to worry about getting sick, taking care of ill family members, or not having time for a vacation.
In reality, unlimited time-off policies lead to ambiguity and reduced time away from work. A 2018 study found that employees with unlimited time off took only 13 days off per year, while those with defined paid leave policies took 15 days.
Thirteen days is enough for one traditional vacation, unless you get sick.
When You Don’t Have Paid Leave, What Do You Do?
We’re illustrating the lack of paid time off to get to a crucial point, the ultimate reason everyone should lobby for mandatory paid sick leave policies.
What do people do when they can’t stay home when sick?
They go to work sick. People who should be home in bed get themselves up and go to work because they can’t afford not to. They also skip the doctor, prolonging illnesses because they don’t get the medication or care they need for a swift recovery.
Sick Workers Impact Everyone
Think about how dangerous it is to have people with headaches and head colds commuting to and from work. Imagine how many mistakes these people make on the job because they can’t concentrate. Consider how many others get infected because contagious people can’t afford to miss work.
Now think about the 50% of low-wage workers who don’t have access to any paid time off at all.
What industries do you think they work in?
Retail and food service tend to be the lowest-paying sectors, which means the people who make your food and bring it to you are the people who aren’t allowed to be sick. The people who are bagging your groceries and handling your money are the ones who can’t afford to stay home.
Being sick is a privilege that these workers can’t afford, and in the end, we all end up paying, especially when they share their germs with everyone they come into contact with at work.
Sending Kids to School Sick
Being sick is a privilege for the children of these workers as well. Many send their children to school with colds because they can’t afford to take a day off to care for the sick kids. Imagine whether these children are capable of learning while suffering from chills, fevers, headaches, and sore throats.
In addition, there’s the contagion factor. Schools and daycares are notorious germ factories. Sick children go to school, spreading their germs around. Parents go to work, spreading the child’s illness to coworkers and customers.
These things happen every day because businesses can’t be bothered to offer employees the basic human dignity of being sick, and governments do nothing to help.
The Other Privilege: Access to Healthcare
Halfpoint via Shutterstock.com.
Being sick isn’t just a privilege for those who can afford to stay home. It’s also a privilege for those who can afford healthcare.
Even with the expansion of Medicaid and the Affordable Care Act, a little over 8% of Americans lacked health insurance coverage in 2024. With changes in eligibility from new laws passed in 2025, that number will likely skyrocket.
But insurance coverage is just a small part of it. Healthcare affordability is a massive problem even for those who have it.
Millions Can’t Afford Healthcare
In late 2023, the Commonwealth Fund conducted a survey to see how dire the situation really is. The results showed that most Americans, even those who are insured, can’t afford healthcare.
Slightly over 50% of survey respondents said it was “somewhat” or “very” difficult to afford healthcare costs. Nearly 40% said they delayed or skipped needed healthcare because they couldn’t afford it, and half of those said a medical problem got worse as a result.
Nearly 60% said that 10% or more of their budgets go to healthcare costs, and 30% said healthcare costs make it harder to afford life. Some (16%) are even considering dropping insurance coverage because it’s too expensive.
So even if you have a job that offers insurance, that doesn’t mean you can afford to participate. Even if you have time off, that doesn’t mean you can afford to see a doctor for meds or for that much-needed excusal letter.
Being Sick Shouldn’t be a Privilege
We can do way better than this in the wealthiest country in the world. Being sick shouldn’t be a privilege. It’s something that every single person on the planet experiences.
People in any occupation should be allowed the basic human dignity of staying home with the flu or taking care of sick children. It shouldn’t cost them their jobs or livelihood.
They also shouldn’t have to choose between paying for a doctor and paying for food. We should have access to medical care when we’re sick, to keep the populace strong and healthy.
We can do better for our people. Why don’t we?