Rail Workers USA

Given the level of attention to the recently imposed freight rail contract that provides no, zero, acute sick days for railroad workers earning an average wage of $64,210 (before the recent 24% increase spread out over 5 years), let’s remember their huge toll of Covid-19 cases as shown in this table of infected rail workers from the Federal Railroad Administration. (1)


And let’s remind ourselves how terribly the US compares to the rest of the developed world in minimum sick days that are mandated for workers on a national basis. (2)

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Then let’s recall that despite being the richest country in the world, the US has the worst health outcomes among developed countries. (3) Moreover, within the US there are huge disparities of health and benefits based on race as well as class (for an overview, see https://multiracialunity.org/2017/04/13/racism-is-a-scourge-on-the-publics-health/), a fact that helps to hide this woeful state of affairs, blame it on the most deprived, and diminish the struggle for change.

Sickness Among Workers Spreads Disease and Costs Money

Workers who get sick are not just a problem to themselves because of pain and suffering with possible long-term consequences, lost income, contagion, and family difficulties, but society has a lot to lose too. Sick workers without sick pay are 1.5 times more likely to go to work with a contagious illness than those with this benefit. Three million unwell workers go to work each week, mostly low wage earners, mothers with young children or both. Moreover, most have jobs such as restaurant or child care workers that directly interact with the public. It was estimated that five million people contracted swine flu in 2009 because of lack of sick leave. (4) Temporary emergency paid sick leave for Covid through the Families First Coronavirus Response Act of 2020 is thought to have prevented 400 Covid cases in each state.(5)

Capitalist enterprises may think they are saving money by not offering sick days, but they are actually hurting themselves as well as the society at large. Paid sick days lead to more preventive care, like vaccinations, and getting earlier treatment when ill and thus avoid preventable emergency room visits. This alone would save an estimated $1.1 billion annually. 4Workers who go to work sick are also 38% more likely to be injured on the job than those who can take time off, and the resulting loss of productivity at work is estimated to cost about $208 billion annually. Access to sick pay also reduces the chance of job loss by one fourth over five months, while a need for new workers increases bosses’ costs for new worker recruitment and training. (6)

Who Has Sick Days

As of March, 2022, over 33 million workers in the US lack even a single sick day, which is disproportionately true of low wage service workers. 55% of retail and fast food workers are in this category. Only one fifth of workers with the lowest 10% of private salaries have sick days compared to near 90% in the top tenth of wage earners. Almost half of working mothers — 54% of Latin and 42% of black mothers — have no paid sick time. 6A little over half of hourly service workers at 91 large companies like Costco and Walmart have paid leave, although the figures vary widely.(7)

Even though worker organizing in 15 states and dozens of cities has resulted in laws mandating sick time, there is no such federal law, and 24 states actually have statutes preventing cities and counties from enacting their own laws. 6 The federal Family Medical Leave Act of 1993 provides up to 26 weeks off a year for unpaid medical leave for one’s own serious illness or to care for a sick family member, but it has many restrictions. The employee must have worked for a firm with at least 50 employees for at least 12 months and for at least 1250 hours a year. Only 59% of workers meet these criteria. (8) In the case of rail workers, the requirement that the worker has put in 1250 hours over the past year excludes many because hours on call do not count, which may be 24 hours a day, seven days a week. (9)

Everything Is Worse Without Insurance

As of 2021, 30 million people, 9.2% of Americans, had no health insurance, the main problem being affordability. The highest percentage of the uninsured is those of working age, 19–64, and is disproportionately black and Latin, the latter group being 30% uninsured. (10) Approximately 5.2 million people have gained health coverage since 2020 via the American Rescue Plan, which has increased marketplace subsidies and expanded Medicaid.4 Although originally expected to end in 2022, the Inflation Reduction Act has now extended these benefits through 2025. (11) Then, who knows?


According to the Commonwealth Fund Biennial Health Insurance Survey of a representative sample of adults,

  • 43% of those of working age are still inadequately insured in 2022
  • Of these, one tenth had a gap in coverage during the past year
  • For nearly a quarter their coverage does not provide affordable access to care.
  • Half said they could not pay for an unexpected medical bill of $1000 within a month, which includes 68% of black and 63% of Latin workers.
  • Undocumented immigrants, about 12 million people, are ineligible for any federally subsidized insurance
  • 12 states that have not expanded Medicaid have huge uncovered medical cost risk.6
  • The result of these large gaps in coverage is that one fourth of people with chronic diseases like diabetes have skipped prescriptions because of out of pocket costs.11

The Overlap of Sick Pay and Health Insurance

It is very difficult to find data that show the combined effects of sick days and health insurance. The table below, although nine years old, illustrates that the combination of lack of both sick leave and insurance leads to the highest incidence of delayed medical care, while those with insurance and sick days do better than those with the ability to take time off but no insurance to pay for care. Doubtless the same is true today. (12)


Railroad workers, one group of insured workers without sick days, may take occasional personal days, but even these must be scheduled at least 48 hours in advance and so are useless for acute illnesses, which includes most infectious ones. If a worker does call in sick, there may be severe penalties, even termination. Since work schedules are irregular and may change at the last minute, it is very difficult to schedule any preventative or chronic health care.

What Is the Remedy?

It is hard to even contemplate the mindset of the US legislators or the President, well paid with generous benefits, who see fit to deny railroad workers even a single paid acute sick day. But it somehow is not out of kilter, not outrageous, in a society where workers are treated merely as means to an end, means to make a profit, rather than as human beings with intrinsic worth. And the disregard continues even though, overall, profits and general social health and costs are negatively impacted.

Partly this reflects the difficulty of planning beyond the next quarterly report under capitalism, always concerned with beating the competition in the here and now. Partly it reflects the need to reinforce the idea that workers, even in their own minds, are only an entity of service to a boss. And, of course, the poorer wages and benefits of black. Latin, women, and immigrant workers serve to physically and ideologically separate us and prevent the massive struggle that would be needed to overcome politicians, corporations, and sold out union leaders.

In order to uplift the status of US workers — from the unemployed to railroad and retail workers, to teachers and nurses — we must build a movement that unites us all. We must come together across all ethnicities and job categories to fight the injustices of this system, which range from working conditions to poor schools, housing and hospitals, to paying for and fighting in unjust imperialist wars. It is critical to build this unity. If we want to consider changing this whole system to one in which we can avoid climate disaster, pandemics, and nuclear war, we must overthrow capitalism and build a society we run ourselves in our own interests, without profits or racism, with only our own well being as its goal.


  1. https://www.trains.com/trn/news-reviews/news-wire/railroad-employee-covid-19-infections-hit-pandemic-high/
  2. https://cepr.net/report/contagion-nation-2020-united-states-still-the-only-wealthy-nation-without-paid-sick-leave/
  3. https://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/#76bd1600576f
  4. https://www.americanprogress.org/article/lack-paid-leave-risks-public-health-coronavirus-outbreak/
  5. https://www.nationalpartnership.org/our-work/resources/economic-justice/paid-sick-days/paid-sick-days-improve-our-public-health.pdf
  6. https://www.abetterbalance.org/sick-without-a-safety-net/
  7. https://shift.hks.harvard.edu/paid-sick-leave-brief/
  8. https://www.kff.org/coronavirus-covid-19/issue-brief/coronavirus-puts-a-spotlight-on-paid-leave-policies/
  9. https://news.bloomberglaw.com/daily-labor-report/rail-strike-threat-brings-new-focus-on-work-attendance-policies
  10. https://www.moneygeek.com/insurance/health/analysis/americans-without-coverage/

10a. https://www.hhs.gov/about/news/2022/08/02/new-hhs-report-shows-national-uninsured-rate-reached-all-time-low-in-2022.html

  1. https://www.commonwealthfund.org/publications/issue-briefs/2022/sep/state-us-health-insurance-2022-biennial-survey
  2. https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0965  

Ellen Isaacs is a physician and anti-racist and anti-capitalist activist and co-editor of multiracialunity.org, where this article was first published.

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