Uncategorized

POLICY: Firing smokers? Who’s next?

One of my favorite non-health care policy organizations, the Drug Policy Alliance, has a flash animation out about an insurance company that fired four smokers for possibly smoking in their free time. The company allegedly believes that it’s OK to fire smokers because their health care costs are likely to be higher than other peoples.  The Drug Policy Alliance folks’ sub-text is of course that what you do in the privacy of your own home away from the workplace is your business and not anyone else’s including your employer, so long as you do a good job in your workplace, and by that they mainly mean pot-smoking.  There was also a great study a while back that showed historically that companies that drug-test their employees do worse in terms of standard business measures like productivity and stock performance than those which don’t.  And of course no one is yet alcohol-testing employees, unless it concerns taking alcohol immediately before flying a plane or something similar which impairs the ability to do a good job.

But the key points in this "firing smokers" issue were drawn home to me while watching a Harris Interactive webinar yesterday. (The webinar will likely be up here sometime soon but doesn’t seem to be up yet.) They’ve done a lot of work about the obesity problem, and as their colleague Bill Rosenberg said it’s getting clearer that there’s little point in a company trying to do anything to reduce the obesity in its workforce  — there’s no ROI there.  So the next best option to reduce health care costs is of course to get rid of those who cost the most.  Once we’ve got rid of the smokers, drinkers, druggies and perverts, then who’s next?  The obvious answer is that it’s the fat and the sick, who of course tend to be lower paid than average, which in turn means that their health care costs are a higher proportion of their overall compensation.

I also had a recent meeting with Brian Klepper and Patricia Salber of the Center for Practical Health Reform.  They believe that employers are dropping out of offering benefits rather more rapidly than the overall figures suggest, and Brian points to a study showing that only 45% of jobs come with health insurance (as opposed to 62% of people getting their health insurance via someone’s insurance), and that the percentage of jobs offering insurance is going down by up to 5% a year. And of course the amount of coverage being offered in the brave new high-deductible world is at least somewhat (and maybe greatly) less than people were used to a few years ago. They believe that this is leading to a crisis of funding for the whole system, and have some interesting ideas about what to do.

But in the absence of reform (which will last at least another 4 years) there’s a very nasty scenario in all of this.  Employers may actively start looking at their workforce with an idea of who to keep in and who to kick out, based purely on their health status.  After all insurers have done this for years, to great effect on their bottom lines.  Now that many big employers really see health care as their biggest challenge, and small employers get the picture too, what’s to stop them really looking at the pre-cursors for health care costs and getting rid of people who smoke, look fat, or like a drink, or are getting old?  Nothing really, especially as a class-action lawyer won’t take on a small company because they haven’t enough money to be worth taking down. Particularly for a small employer, they don’t have to state anything in their policies about it, or even look into medical records, as those things are pretty self-evident.

And of course the costs of this end up on the individual and the taxpayer.

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

Tagged as: ,

6
Leave a Reply

6 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
5 Comment authors
JohnTerry NugentRickanonymousMatt Recent comment authors
newest oldest most voted
John
Guest
John

Here’s what Howard Weyers, the guy who runs Weyco, had to say about this. Smoking Is Not a Civil Right: Viewpoint by Howard Weyers, President, Weyco, Inc. OKEMOS, Mich., Feb. 9 /PRNewswire/ — The following is a viewpoint by Howard Weyers, President, Weyco, Inc.: Rather than face the dangerous realities of smoking, critics of Weyco’s tobacco-free policy rush to the so-called “slippery slope” argument, imagining all kinds of dire consequences for workers. But the fact is, federal and state laws prohibit employers from discriminating on the basis of age, sex, race, weight, national origin, and other attributes — and smoking… Read more »

anonymous
Guest
anonymous

I like the lawsuit-free scenario where employers voluntarily realize that everyone needs to be able to work in order not to fall back on public support. In order to avert the all-to-human problem of discrimination, employers voluntarily implement an impressions-blind hiring system. Employees thus hired would be responsible for meeting the requirements of the job, and managers would be responsible for reporting whether those requirements are being met. People problems could then be worked out between the people involved, with the manager only serving as referee in conflicts of interest. Then watch healthcare costs miraculously plummet as quality of life… Read more »

Terry Nugent
Guest

Somewhere along the line there will be litigation pitting the rights of corporations vs. individuals, probably using the Americans with Disabilities Act or parallel logic along the following lines: if lifestyle generated characteristics such as obesity or substance dependence are a function of genetic predispositions, are these not disabilities? And if so, is it not discriminatory adverse selection to take such disabilities into account in hiring and firing? One can envision armies of obese smokers of legal and illegal substances being unleashed upon corporate whipping boys such as Wal Mart or Spitzer’s target du jour by the feds, state AGs… Read more »

Rick
Guest
Rick

I can’t agree with your predictions of a nasty scenario, and provocative suggestions of “who’s next?” Any attempt to fire the fat and sick over their cost would meet with a backlash sooner or later because there’s no clear link between a voluntary act and being fat and sick. Nature or nurture? The jury is still out. Not so smoking. Smoking is a voluntary act (Well, OK. Starting to smoke is. Thanks to “The Insider,” we know about the chemistry of addiction and so forth). And it’s the single most costly voluntary act in terms of driving up healthcare costs.… Read more »

anonymous
Guest
anonymous

Wow – I have so many things to say about this, I don’t know where to start. First, employers are already less inclined to hire the fat, sick, etc. in the first place. Legislating against discrimination doesn’t matter because companies can use outside recruiters to hire and only continue to hire recruiters who bring them the candidates who “fit”. Over the last year, I’ve been called by many recruiters who have been enthusiastic about my resume, who have confirmed I have the skills and work habits they need: but then their job order mysteriously changes after they meet me in… Read more »

Matt
Guest
Matt

Wouldn’t such class action suits now be heard (or not heard) in federal (vs. state) courts?