Tobacco Tests for Employment

I know this topic isn't specifically about my weight loss journey, but it is directly related to health and wellness. The first I heard of an employer not hiring individuals based on their decision to smoke was the Cleveland Clinic. Their CEO takes health issues very seriously (going so far as saying "If I could, I would not hire obese people"), and since 2007 they have had a non-smoking policy for new hires and residents (this, of course, is a simplification of the full policy). Without a doubt, the Cleveland Clinic is a national (if not world) leader in health care delivery, but do they go too far with this policy?

In full disclosure, I enjoy the occasional cheap cigar and have been known to share a hookah amongst friends. In spite of these unhealthy indulgences, I am torn on whether these policies are ethical. On one hand this is an issue of personal freedom. On the other hand there is a pragmatic realty that tobacco-related disease is a huge drag on health care expenses (and in turn health insurance premiums).

The Cleveland Clinic can also claim they are a health care delivery system, and they have a duty to create a healthy community (community wellness, by the way, is a key concept in Accountable Care Organizations, a big part of Obama-care); how better to start on improving the health of its own community than by looking within? If health delivery organizations get a free pass, what about other companies such as Wal-Mart offering discounted health insurance for non-smokers?

I love a good policy debate, but that is not the purpose of this blog post. It is to illustrate that companies are becoming wiser to how an individual's choices impact their annual insurance premiums. It is hard to blame them, as it now costs on average $5,429 per individual and $15,073 per family per year for employee-provided health insurance (compare that to the $100/month you are putting in, and think about how much the employe needs to make up).

How do we bend this cost curve? There are a lot of issues in our very inefficient (and comparatively ineffective) U.S. health care delivery system that need to be addressed, but one of the top four drivers in health care costs is the management of chronic disease (diabetes, heart disease, etc.). Knowing that money in and of itself will not drive a long-term change in behaviors (unless, of course, you are in sales or banking), the cost of not taking care of myself today is a driver in the change of my behavior. Simply put, I don't want to pay for blood pressure, arthritis, or diabetes medication when I have the ability to avoid it.

I suppose at the end of the day I would honor my employer's policies. I do question the long-term effectiveness of the heavy handed approach, but if it saves a few lives and makes the insurance risk pool less expensive it could be considered a success.