He Who Pays The Doctor Calls The Tune

Common sense or a troubling invasion of privacy?

Hospitals Shift Smoking Bans to Smoker Ban

By A. G. SULZBERGER

Smokers now face another risk from their habit: it could cost them a shot at a job.

More hospitals and medical businesses in many states are adopting strict policies that make smoking a reason to turn away job applicants, saying they want to increase worker productivity, reduce health care costs and encourage healthier living.

The health care cost argument could be advanced by any employer that sponsors a health plan that can't incorporate a smoker's premium in the rate.  As to productivity, I can picture two issues: lost employee time due to increased sick days, with the associated aggravation of bringing in temporary replacement workers; and lost time each day as the smokers trudge to ad from the few remaining legal smoking sites.

The policies reflect a frustration that softer efforts — like banning smoking on company grounds, offering cessation programs and increasing health care premiums for smokers — have not been powerful-enough incentives to quit.

The new rules essentially treat cigarettes like an illegal narcotic. Applications now explicitly warn of “tobacco-free hiring,” job seekers must submit to urine tests for nicotine and new employees caught smoking face termination.

This shift — from smoke-free to smoker-free workplaces — has prompted sharp debate, even among anti-tobacco groups, over whether the policies establish a troubling precedent of employers intruding into private lives to ban a habit that is legal.

First they came for the smokers...

If the issues are health care costs and lost sick days (rather than marching to and from safe smoking zones), other activities might one day be targeted:

One concern voiced by groups like the National Workrights Institute is that such policies are a slippery slope — that if they prove successful in driving down health care costs, employers might be emboldened to crack down on other behavior by their workers, like drinking alcohol, eating fast food and participating in risky hobbies like motorcycle riding. The head of the Cleveland Clinic was both praised and criticized when he mused in an interview two years ago that, were it not illegal, he would expand the hospital policy to refuse employment to obese people.

“There is nothing unique about smoking,” said Lewis Maltby, president of the Workrights Institute, who has lobbied vigorously against the practice. “The number of things that we all do privately that have negative impact on our health is endless. If it’s not smoking, it’s beer. If it’s not beer, it’s cheeseburgers. And what about your sex life?”

If we want to live in a world where everyone gets their health insurance at the same price regardless of pre-existing conditions or risky lifestyle choices, then the healthy and prudent should resign themselves to subsidizing everyone else.  Oddly, Obamacare is the solution here (if it lives that long!) - employers will have yet another reason to dump their employees into the subsidized exchanges and let We The People handle the subsidies to the risk-seekers.

Let's note that there are some legal issues that would also prompt companies to prefer to terminate their employer-sponsored plans:

About 1 in 5 Americans still smoke, and smoking remains the leading cause of preventable deaths. And employees who smoke cost, on average, $3,391 more a year each for health care and lost productivity, according to federal estimates.

“We felt it was unfair for employees who maintained healthy lifestyles to have to subsidize those who do not,” Steven C. Bjelich, chief executive of St. Francis Medical Center in Cape Girardeau, Mo., which stopped hiring smokers last month. “Essentially that’s what happens.”

Two decades ago — after large companies like Alaska Airlines, Union Pacific and Turner Broadcasting adopted such policies — 29 states and the District of Columbia passed laws, with the strong backing of the tobacco lobby and the American Civil Liberties Union, that prohibit discrimination against smokers or those who use “lawful products.” Some of those states, like Missouri, make an exception for health care organizations.

"Lawful products" certainly includes cigarettes, motorcycles, beer and french fries.

Comments

[Jane (sit on the couch or save your country)]

“We felt it was unfair for employees who maintained healthy lifestyles to have to subsidize those who do not,” Steven C. Bjelich, chief executive of St. Francis Medical Center in Cape Girardeau, Mo., which stopped hiring smokers last month. “Essentially that’s what happens.”

Isn't that the entire point of Obamacare?

[clarice]

I never missed time because of smoking and my medical bills were always minor when I was employed. I insurance companies have different experiences perhaps the burden of the extra costs ought to be borne by the employees. Beats not hiring or firing them. And then there's the monitoring issue. PHEH

[Captain Hate]

This has been the policy of the Cleveland Clinic for quite a while. Even though I'm not a smoker, it's always smacked of Nanny state garbage. Working in IT, some of the most brilliant people I've worked with have been smokers and it would be imbecilic to base a hiring decision on that, no matter my opinion of the habit.

[sbw]

A Democratic Party administration is another lawful product ... at least under the opinion issued by Holder's DOJ.

[MarkO]

Watch your carbs, gang. You could be next.

[Porchlight]

Sounds like a great way to boost unemployment. Third shifts don't appeal to everyone and hospital work is stressful - do we really want to turn down potentially great ER employees just because they dash out for a smoke on their 4 am break? And don't we already have a shortage of nurses?

[DrJ]

This is a damn good reason to run your own business. Then you don't have to put up with this sort of nonsense.

[Kills bugs kwik.]

Nicotine is a good drug. We just shouldn't inhale it as tobacco smoke.
==============

[Abadman]

The hospitals are running their own business.

The hospitals might miss out on some good people but that is their choice.

The so called nanny state is pushing back against this telling companies they must hire smokers not that they can' t hire them.

I am not saying I agree with the policies just that I think some of the criticism is missing the mark

[Jane (sit on the couch or save your country)]

Actually Abadman I agree with you. Back in the day I could never understand why businesses had to be forced to hire women. I figured that they missed out on us at their own peril.

[Janet]

First they came for the smokers...

The new world order. Look out you sugar eaters.
♪ ♫ The land of the free ♫ ♪ ...I don't think so anymore.

[Walter]

In the coincidence department:

Last night I popped out to the local Starbucks for a mocha and some Kindle time. While I was trying to focus on my book, the --- at the table behind me was succeeding at using the place as an office, complete with multiple calls, computer, etc. Turns out it was the same Mr Sulzberger who wrote the article above, reporting from the County Seat¹ on the tribulations of our local playboy billionaire.

Can't properly express the schadenfreude that the article only made A13 in the print and never got play on the paper's website.

________________
¹It's datelined from the next county over. There is only so much fact-checking one can do in a coffee shop.

[mockmook]

A better solution?

Hire smokers, but don't provide them insurance; and set a lower wage based on projected absenteeism.

----

Surely, if I can discriminate against smokers, I can discriminate against "practicing" gays, right?

Both are voluntary behaviors. Both are statistically risky.

[Captain Hate]

I am not saying I agree with the policies just that I think some of the criticism is missing the mark

Hmmm my previous response to this was eaten by this POS wonderful software. Yes I erred in my invocation of the nanny state but what is to happen to existing smoking employees when they institute this policy. And per Janet what legal activity do they set their sights on next: sugar, alcohol, fried foods....

[Porchlight]

I am not saying I agree with the policies just that I think some of the criticism is missing the mark

Good points, abadman. I admit I wasn't paying close enough attention to the story.

[daddy]

Why its like its 1604 all over again:

From King James 1 (The Bible guy):

"Smoking is a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is bottomless.”

Even worse, "the herb was introduced neither by king, nor by great conqueror, nor by learned doctor of physics, but was adopted from “unbaptized barbarians [Indians in the Americas]”.

King James 1 ">http://www.stopsmokingsteps.com/2009/09/26/king-james-i-and-tobacco/"> "A Counterblast to Tobacco".

PS. His answer was taxes.

[JM Hanes]

"job seekers must submit to urine tests for nicotine and....

It would be more accurate to say that employees will have to submit urine on demand. How long does anyone expect the Feds to resist such a ready made testing vehicle for everything else in the name of preventative care -- with law enforcement standing in line? Feed the results into the electronic medical records database, and you've got a gold mine for comparative effectiveness research.

"“We felt it was unfair for employees who maintained healthy lifestyles to have to subsidize those who do not."

Thus do we demonstrate the cognitive dissonance required to conflate healthcare and insurance. But Bjelich goes one better: We will insure only the healthy! So much for Obama's pre-existing conditions; St. Francis Medical Center will soon be awarded block grants for their pilot program in cost reduction.

Escalating sin taxes is a similarly popular option too, because, of course, sinners deserve to pay. The opportunity for moral preening is just the icing on that self-jusifying cake. Best keep that weight down, though, or prepare to pay by the actuarial pound.

[Roux]

Next it will be alcohol and then chocolate. It will never ever stop.

[Janet]

I don't get it...
Smoking, eating the wrong things, overweight = bad
Lie, cheat on your taxes, sleep around, divorce = neutral or nobody's business
Sodomy, extreme sports, smoking pot = okay or even cool

Does a smoker cost more than an unwed mother? a promiscuous employee - gay or straight? how about an exercise addict with knee or joint trouble?
As long as ALL behaviors are factored into the cost...physical & moral.

"About 1 in 5 Americans still smoke, and smoking remains the leading cause of preventable deaths. And employees who smoke cost, on average, $3,391 more a year each for health care and lost productivity, according to federal estimates."

I have grown leery of 'federal estimates'!

[Abadman]

CH

I Agree the policy is intrusive, unfair to currently employed smokers and counterproductive.

[AJ Lynch]

Some studies have shown smokers, on average, are more productive than non-smokers. Could involve the addiction gene or some such.

Re the disparity re smoker premium for insurance, the solution is just give every employee the same amount of cash so they can go buy their own insurance. That would also eliminate the disparity where married workers get a higher employer subsidy when they choose a family policy.

[cathyf]

This is actually a particular problem with self-insuring entities which have too small a covered pool.

For example, at DrF's institution there is a polisci professor who at first blush seems to be a barking moonbat, but is, in fact, a poster child for Asperger's Syndrome and the high-functioning autistic utter cluelessness. A couple of years back the claims management company instituted a program where they were requiring prescriptions to go through the discount mail-order pharmacy. Our aspie gal wrote an email to the entire staff, complaining that her prescription costs were going to go up a huge amount if she didn't use the mail order, and a significant amount even if she did, and it was terrible to expect her to pay $90/month for her drugs, etc.

I, ever the economist's daughter, said to DrF -- so, does she REALLY want to draw the attention of her colleagues how much her drugs are costing the college's self-insured plan? Does she REALLY want to have the personnel committee thinking, "hey, if we deny her tenure, then our insurance premiums go down!"

[DrJ]

give every employee the same amount of cash so they can go buy their own insurance.

That's what I do, though I offer insurance through the company. Why should a single person have to support the health insurance payments of a family with nine kids?

[cathyf]

DrJ, I hope you subtract the full costs of the premiums from the employees pretax pay, so that neither you nor the employees have to pay social security or medicare tax on the money, they don't have to pay income tax on the money, and you don't have to pay unemployment tax on the money. Otherwise, may I be the first taxpayer to stand in line and thank you and your employees from paying extra taxes that you don't have to pay...

[uta]

Make it illegal like alcohol.Its just destroys the body and no one needs them.

[DrJ]

I hope you subtract the full costs of the premiums from the employees pretax pay

I do.

[Sue]

What about the guy that rides his motorcycle too fast without a helmet? Or rides bulls on the weekend as a hobby? Or drives too fast on a slick highway? Or the sky diver, scuba diver, mountain hiker, snow skier...I could go on. Where does this risky behavior stop?

[Pagar]

Hold the presses--the Powers that Be site has found a new preexisting condition that may affect up to 800,000 employed Americans. Obamacare will eliminate it.

LUN

[tommy mc donnell]

"the healthy and prudent should resign themselves to subsidizing everyone else." thats the way socialism works you punish the people who do what right to reward the people who do whats wrong. thats social justice you know.

[Pops]

It is simply FALSE to claim smokers put all these addtl costs on employers, or their fellow man.

From my experience, people with kids spend far more time out of work for sick kids, doctor visits and catching diseases the kids bring home from school.

Let's stop hiring people with children.

[jorod]

Nicotine is a cheap anti-depressant and a stimulant. Will employers pay for a switch from nicotine to a prescription for anti-depressants or stimulants. Nicotine in cigarette smoke also relieves the symptoms of colitis. Should we replace it with prescription medicine? Steroids? What about caffeine? Doesn't it increase blood pressure? Should we ban it? What is the link from stomach cancer to coffee?

[MarkD]

Old people definitely cost more, so we should discriminate against the aged. Except it's illegal. Except I'm one of them. The alternative to getting old isn't attractive to me.

My health insurance has made money off of me. May it continue to be that way.