I get a lot of press releases from health insurers, government agencies, think tanks, etc. that seem to assume that we workers all have stay-at-home spouses to take care of us, employers that offer easy access to sick days, and, to boil it down, long, lazy days to work at setting up doctors’ appoints, meandering from one heavily discounted independent blood testing or radiology center after another, and enjoying back issues of People magazine in waiting rooms.

To paraphrase what a marriage counselor said to a harried friend during a recent office visit, “You can make time for these things. You have to manage your priorities. You can always get another job.”

Of course, there is no greater joy in life than to read an old People magazine in a medical office waiting room, but the truth is that, in this economy, you can’t always get another job.

An employer might offer the most generous sick-leave policy possible, and the managers may genuinely want employees to get care when, for example, they are starting to cough up dark green phlegm or have 103 degree fevers, but that doesn’t mean that the employees believe they can really take off a day from work just because they happen to have a 103 degree fever.

Even if the company has successfully communicated the idea that coughing up blood is a reasonable excuse for taking a sick day, that doesn’t mean, in this lean and mean age, that there are alternative employees still around who can do the sick employee’s work. Today, conscientious employees know that missing a day of work may mean that truly essential tasks get skipped, or done poorly.

Meanwhile, we have doctors, policymakers, government agencies and think tanks waxing eloquently about how wonderful it would be if patients had medical homes, where a kind and Dr. Marcus Welby, M.D.-like primary care provider would use personal electronic health records created by armies of invisible workaholic elves to know about every dougnut a patient had eaten back to the day the patient was born.

Of course, that kind of loving medical home is certainly what children and people with complicated or chronic health problems need, but what ordinary healthy working adults actually need is a telephone number of website they could use to line up a slot in the office of any nearby, licensed, non-imprisoned health care provider who could treat them quickly, in the scraps of time available for attending to personal needs, at some kind of affordable price.

When I look at my health insurer’s provider director, I see hundreds of listings for ordinary doctors who really don’t want to see me any time soon, and maybe 5 listings for urgent care centers or walk-in clinics. Something is seriously wrong with that directory.