The Classism of Doctor’s Notes in the United States

A lot of times, social media can be a dumpster fire. But sometimes, there are people on social media who make interesting points, and such was the case with one quote I came across:

“Requiring doctor’s notes to excuse absences due to illness is inherently classist in a country w/o universal healthcare and I really wish we talked about it more.”[1]

Upon thinking about this tweet, the person who tweeted it was right: requiring a doctor’s note to excuse absences due to illness is classist in the United States, a country that unfortunately lacks universal healthcare. So, let’s talk about it more.

Many schools and workplaces require someone who’s been out sick, and particularly someone who has been out sick for more than a certain period of time, to give a doctor’s note explaining the person’s absence upon their return to school or work. For many of us, in the cases of a multitude of illnesses (though not all illnesses), it’s simple enough: you go to a doctor, you get something checked out, you find that you are ill with something that keeps you out of school or work for several days or a couple of weeks (like strep throat, an ear infection, etc.), the doctor gives you a note to present to a teacher or employer showing that you were indeed sick with something, you give the note to your teacher or employer, and then you move on.[2]

In the United States, where there is not universal healthcare, not everyone has health insurance because not everyone has a job with insurance or afford to buy insurance if they lack it through their job. Due to how a lack of health insurance can make it prohibitively expensive to visit a doctor (which seems to cost in the $300-$600 range for those who don’t have insurance to cover the visit, per what I looked up online) or even an urgent care clinic (which is less expensive than seeing a doctor without insurance, but still can be in the $100-$200 range apparently), some Americans have a difficult time affording the requisite visit to get that doctor’s note upon their return to work or their kid’s return to school. What are those people to do?

This problem should be especially noteworthy for employers that do all they can in order to avoid paying for health insurance for employees, or employers (oftentimes small businesses) who struggle to afford to pay for adequate health insurance for their employees. As a result, some employees are unable to afford doctor’s visits in general—an injustice in and of itself that prevents people from getting requisite doctor’s notes and has personal and public health ramifications that go well beyond doctor’s notes.

So what is the solution to this doctor’s note classism in the United States?

The long-term solution is universal, affordable health care of some sort so that every single American can be able to go to the doctor when they are unwell. This addresses the issue of being unable to afford a doctor’s visit—which enables someone to get a doctor’s note when they need it. But it has personal and public health benefits that go well beyond the ability to get a doctor’s note. However, to be completely realistic, Congress barely got Obamacare passed and signed into law in the United States (inadequate as it may be in terms of providing truly universal care), and the political situation in the United States is somehow even more toxic now than it was then. In other words, my pessimistic realism is telling me that it may be some time before we get truly universal healthcare. I hope I am wrong.

In the interim, I think that many bosses with uninsured or underinsured employees need to be sensitive to the fact that for some employees, all they can do to get better is to simply rest. As such, sick leave policies should reflect that fact. Admittedly, such an approach requires a certain level of trust in employees that some employers lack (and there are unfortunately some people in this world who give reason for having low trust in employees, but there are also many deserving of that trust). However, the alternative is worse: forcing a poor, uninsured person to come into work sick because they cannot afford to get the doctor’s note necessary to show that they are sick.


[1] https://twitter.com/fortunafiasco/status/1048369825045573633

[2] However, it is worth noting that there are some illnesses where things like rest and fluids are needed far more than a visit to the doctor. Asking for a doctor’s note is problematic in those sorts of situations as well, albeit such situations are not the focus of my post here.

The Classism of the Trump Administration’s New Guidelines on Legal Immigrants

Last week, it was announced that the Trump administration would have a new regulation, called a “public charge rule,” where (from my understanding) someone applying for admission to the United States or someone who is looking for a change in residency status could be denied their request if they are deemed as likely to be a “public charge” in the future.[1] In other words, if the applicant is deemed to be likely to need some public benefit in the future, such as food stamps, then their application would be denied under the new guidelines.

Critics of the law have deemed this law anti-legal immigration, and those critics are right. Some critics have also deemed that this is anti-poor people, and they are right. However, there is one big word that must be used to describe this rule, a word I don’t seem to hear at all.

That word is classist. Yep, this policy is classist, and blatantly so.

Classism is “prejudice and discrimination based on class,”[2] according to the Merriam-Webster Dictionary. Class is “a group sharing the same economic or social status.”[3] Therefore, a set of guidelines that punishes people for being poor is classist. A rule that keeps people from obtaining green cards or U.S. citizenship because they are deemed as poor enough that they are likely to need Medicaid in the future, which is what these guidelines do, is classist. A rule is classist when it is defended by a Trump administration official by saying, “Give me your tired and your poor who can stand on their own two feet and who will not become a public charge.”[4] The rule is classist, and the defense of the rule is also classist.

And yet, it seems like few people, Republicans, Democrats, or people outside the political system, have actually gone as far as to say that it is classist or even mention the word classism. As I’m writing this, I did a Google Search for “classism Trump administration” within the last 24 hours (I wrote this about 24 hours after the rule was announced) and only found five pages of search results. It’s as if classism itself is not really on the radars of that many people.

Given the fact that the Trump administration’s recent action, it’s time to put classism on the radar, learn about it, and call it out for what it is. Republican and Democratic leaders may be hesitant to call out classism, let alone call it out for what it is, but that should not keep us from being frank about classism and classist policies.


[1] You can find the original source of the rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-17142.pdf. Alternatively, if you just want to read a summary of the rule, you can read the BBC’s summary here: https://www.bbc.com/news/world-us-canada-49323610

[2] https://www.merriam-webster.com/dictionary/classism

[3] https://www.merriam-webster.com/dictionary/class

[4] https://www.npr.org/2019/08/13/750726795/immigration-chief-give-me-your-tired-your-poor-who-can-stand-on-their-own-2-feet