Wednesday, February 01, 2006

On Firing Smokers: POST #1 - Cleansing the Workplace to Reduce Health Care Costs

Since a major national anti-smoking group has expressed support for firing smokers in the workplace in order to save employers health care costs and protect nonsmoking employees from having to "subsidize" health care costs for smokers, I feel compelled to offer a detailed commentary on this policy issue. This is the first of a three-part series devoted to this important issue.

The background for this commentary is as follows:

According to a press release issued by Action on Smoking and Health (ASH), a Washington, D.C.-based anti-smoking organization: "firing smokers is an appropriate and very effective way to stop burdening the great majority of employees who wisely chose not to smoke with the enormous unnecessary costs of smoking by their fellow employees."

The Rest of the Story

If ASH is truly concerned about the health care costs borne by employers and the burdens on healthy employees of subsidizing the costs of health care for those who are ill because of poor personal choices, then I think there is a far more effective way of accomplishing its objectives.

I call it my Workplace Cleansing Program. The idea is to cleanse the workplace of people who burden their fellow employees by incurring increased health care costs. Here's how it works:

Every year, the employer provides a questionnaire to employees inquiring about their behaviors and use of health care in the past year. Employers are asked to report the number of emergency room visits they and their covered spouse and dependents made during the previous year, the number of inpatient hospitalizations, the number of outpatient hospitalizations, the number of surgeries, their most recent cholesterol level, their most recent blood pressure reading, their weight and height, and the number of servings of eggs, steak, french fries, and Krispy Kreme donuts they eat during an average week. And here's the policy:
  • If you or your covered spouse and dependents report more than a total of 3 emergency room visits in the past year, you are fired.
  • If you or your covered spouse and dependents report more than a total of 1 inpatient hospitalization during the past year, you are fired.
  • If you or your covered spouse and dependents report more than 2 outpatient hospitalization during the past year, you are fired.
  • If you or your covered spouse and dependents report any surgeries during the past year, you are fired.
  • If your cholesterol or that of any covered family member is greater than 240, you are fired.
  • If your body mass index is greater than 30, you are fired.
  • If your blood pressure is greater than 160 (systolic) or 100 (diastolic), you are fired.
  • If you eat more than 3 servings of eggs, steak, or french fries per week, you are fired.
  • If you eat more than 10 Krispy Kreme donuts per week, you are fired.
The beauty of this policy is that it is much more directly tied to actual health care costs incurred by the employer than a simple policy of firing smokers. After all, firing smokers is a very inefficient way of reducing the health care costs.

There are a fair number of smokers, especially those who are young or who smoke less than a pack per day, who do not incur any health care expenses. And there are a large number of nonsmokers who, for other reasons than tobacco use, incur huge amounts of health care costs.

So to base your entire policy solely on smoking makes little sense. Why not simply base the policy on actual health care use and expenses. This is a far more efficient system, covers all possible causes of increased health care costs rather than just smoking, serves as a tremendous incentive to reduce not just smoking, but to also change other health behaviors, and to address a number of burgeoning public health problems, including the growing problem of overindulgence in Krispy Kremes, which is poised to soon over take Dunkin Donuts as the leading cause of donut-induced obesity.

It also avoids the problem of using just a single question to assess smoking. Such a policy, in which smoking is the only criterion for firing employees, treats all smokers the same, whether one smokes 1 cigarette per week, or 80 cigarettes per day. My policy, on the other hand, is based on actual use of the health care system, so it automatically accounts for differences in cigarette consumption, which will be reflected by different rates of hospital and emergency room use and the need for expensive surgery.

It is also far more fair of a system, because it doesn't penalize light smokers for health care costs that are actually being incurred by heavy smokers. Plus, nonsmokers who are being irresponsible and using their nonsmoking status to allow them to abuse french fries, eschew physical activity, and pay no heed to their weight, blood pressure, or cholesterol, will now be caught for unfairly burdening their fellow employees with their own health care costs.

Finally, my policy, unlike what ASH is apparently calling for, addresses the tremendous problem of health care costs imposed by the spouses and dependents of employees who are also covered by the employer's health insurance plans. No longer would you be able to burden your fellow employees by allowing your wife or children to engage in reckless health behavior.

Within one short year, the workplace would be completely cleansed of those who, because of their unwise personal choices, have been burdening their employers and fellow employees who wisely chose not to engage in behaviors that increase the risk of disease and conditions requiring expensive medical treatment. The savings in workplace health care costs would be immense, there would be a dramatic effect on the public's health (including, I predict, a 40% drop in heart attacks within the first year), and the problem of people keeling over from a heart attack due to spending 30 minutes in a Krispy Kreme store would be all but solved.

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