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You're not an employer. You're a hospitalist. You've never hired anyone in your life except perhaps a cleaning lady, and you have no clue what you're talking about. Therefore why should anyone give two shits about what "you'd do"?
You're taking a figure pulled out of the air as an average ($3400 per year per person) and immediately begin using that sum as if every smoker will cost every employer exactly that much in every single year. Preposterous doesn't begin to describe your positions.
Smoking is bad. People shouldn't do it. We should find ways to lessen the number of people who smoke. As a doctor, anything you say beyond that just shows how far you've got your head stuck up your ass.
After all, pregnancy is voluntary ("The choice is on the employee, 100%."), and obstetrical care -- not to mention the dependents added to the plan -- gets expensive.
There's all that personal time for doctor's checkups, and then they insist on taking maternity leave!
In addition, their absenteeism SKYROCKETS after pregnancy, because they're always staying home to take care of those pesky sick kids, or getting sick themselves.
Better yet, why don't employers just not hire women of childbearing age at all, and save themselves boatloads of money!
/sarcasm for the pig-ignorant who won't get it
There are many organizations that require employees to contract that they do not smoke. I think it's a great idea. The more extrinsic pressure to smokers to quit the better. I have friends who smoke. I have smoked socially in the past (not for months and then very sporadically). But smokers need to take RESPONSIBILITY for their poor choices. I don't think any less of them as human beings. But why shouldn't we as a society have smokers pull their own weight with higher health premiums since they by all statistics prove they use more of the service?
As far as Kris goes I can assure you if you continue to smoke you WILL suffer health consequences. Yes we all have to die of something...It's those years of decreased QUALITY of Life that I'm concerned about.
MLP
anon 10:30 anon. Nonsmokers are being discriminated right now by being paid $3,400 a year less in wages and compensation compared with smokers. If anyone should file suit for discrimination, it is the nonsmokers.
Crankly little prof, it is illegal to discriminate based on sex. At least I think it is. I've never hired anyone as Dinosaur says.
If you're going to discriminate against one part of the population, why be choosy? Why not OTHER members of society who eat up a disproportionate amount of health care dollars?
Why not HIV-+ patients, or those with AIDS? What about the chornically ill (who aren't chronically ill due to smoking)?
Surely it's unfair to the healthy that they "get paid less" because of their chronically ill brethren.
I'm not debating the source of your figures. I'm pointing out that you are misconstruing their meaning.
CLP: You forget to whom you are speaking. According to Happy, ALL chronic illnesses are from smoking.
What you're failing to take into account, Happy, is that employees generate revenue for their employers as well as costs. The skill and productivity of individual employees is independent of their smoking status. A smoker may very well be so productive that even if they miss work more than their less productive colleagues, they are still worth it to the company in terms of the bottom line. Even if they cost extra in terms of health care expenditures, they may very well add many more times that amount to company revenues.
It is possible that a highly qualified smoker can end up being more valuable -- in dollars and cents! -- than three completely incompetent non-smoking health nuts who never miss work, but who never get anything done while they're there either
http://content.nejm.org/cgi/content/short/360/7/699?ssource=mfb
As a non-smoker, I'd be miffed if my co-workers got paid $400 to quit smoking though.
- female nonsmoker without kids
Let me pose the question in this way. If a corporation only offered health insurance policies that explicitly state are for those without nicotine dependence, would that be unfair? If Widget Corporation purchased a health insurance plan in which only non smokers could qualify, would that be discriminatory?
Health insurance is a benefit, not a right. Should they choose to only offer a policy that required proof of no nicotine dependence, should not a company have the right to offer that?
It is, after all a benefit, not an entitlement. You have a right to receive what the corporation offers you. If you don't like what they offer you, you can certainly decline the offer or go work somewhere else.
In fact, who said Widget Corp had to offer you any health insurance? The fact that they do should not lock them into offer insurance to a class that is not protected by any civil liberties.
I would suggest the carboxyhemoglobin test be used as an alternative in that situation.
I'm the night lab tech at your hospital (just might be someday). I'm the gal that likes to work nights and isn't just biding her time unitl a day shift opens up. I'm the gal with 25 years of generalist experience and a specialty in chemistry. I'm the gal that worked every weekend (Fri, Sat, Sun) night for 6 years without one call out. I'm the gal that has been out once in ten years (broke my wrist, slipped on ice and tried to work anyway before I even had a cast but couldn't open the urine cups!) I stayed out for 3 weeks with full pay and benefits because well I had well over 400 hrs ET anyway. Aside from the broken wrist and maternity leave (16 weeks fully paid by accumulated earned time times 3)I have called out of work 3times in 28 years.
I'm the gal you call when no one else can get blood. I'm the gal you call when you need that emergency release yesterday. I'm the gal you call when you want that gram stain read NOW.
I'm the gal that maintains the instruments and reviews all the reports and quality control. I'm the gal that issued all those corrected reports on the bad results that went out while I was off for four days (just about every damned time). I'm the gal that noticed the smear sitting on the desk last night from 2/12/09 with a note to look at the "funny platelets" that everyone ignored and diagnosed the malaria in your mysteriously ill patient.
You would have me fired or forced me to quit smoking - something I very much enjoy (in spite of the risks to my health).
That's fine - I'm sick of the "health care" environment I work in these days anyway. Where some snot nosed doc quotes data dredges from the CDC and thinks he understands science.
Ok - see ya - I'm outta here.
Scalpel. When you apply for any type of insurance related directly to the insuring of your health, they ask you how long you have been nicotine free. The data suggests that the longer you are nicotine free, the more likely you are not to fall off the wagon.
As far as I know, cotinine is the test of choice in determining use of tobacco. You bring up the carboxyhemoglobin. Perhaps it is better. I don't know if it has been verified as a marker of mortality.
I understand the slippery slope between chewing tobacco, smoking and replacement products.
Unfortunately, all of these activities are undifferentiated in the "real world" economics of insurance. Since health insurance is sold in the real world, it is difficult, to near impossible to differentiate the risk between nicotine and tobacco.
Try applying for tobacco free life insurance premiums while taking the patch. It won't happen. Does that make it unfair?
Yes. Perhaps. But like I said, those on replacement products are at high risk, as an aggregate (not on an individual basis) to relapse and therefore are considered the same from a risk stratification.
Dear night lab tech. I'm not sure what your beef is. You sound like one hell of an employee. Somebody who I would WANT to work with any day of the week. You remind me of the same work ethic I employ. I commend you for your dedication.
When I speak of the increased cost of smokers to business, this is not a myth. It is a fact. Is it true for you? It sounds like it's not. But you don't work as a single entity. When you gather 1000 smokers together in a corporation, on average, they will cost the corporation $3,400 a year more than non smokers, according to the CDC. Perhaps you don't believe the data. I suppose that is another issue all together.
Some will cost $10,000, some will cost none.
If you are upset that I think smokers should carry a larger burden of their benefits than nonsmokers, perhaps you should step into the shoes of a nonsmoker and ask why a nonsmoker should pay for the costs of a smoker by way of lower wages of their own.
When a corporation has a fixed pot of money to pay wages and benefits, smokers cost more, on average. So why do you believe you are entitled to collect more in benefits than a nonsmoker?
As far as being snot nosed, that's too bad you feel that way. When I order something stat, it's because I think it's important to have immediate data. I try very hard not to order stuff at irrational hours that require extraordinary effort on the backs of others. I am quite cognizant of the stress of calling people in to do middle of the night testing. But the patient comes first, no matter what time of day it is. If we ever meet in the halls, come say hi. I'm not snot nosed or arrogant. In fact, I understand very clearly that health care delivery is a team effort. I could do absolutely nothing in a hospital wihout everyone's support. And you are a VERY important part of the team. Especially you. Without which I could not make the vast majority of my daily medical decisions.
It does not change the fact that, on average, you cost more to a hospital than a nonsmoker, on average and that means you, as a smoker, are getting preferential treatment, when compared with a nonsmoker, on average.
PS One's carboxyhemoglobin goes up when exposed to second-hand smoke.
Everyone has some risk factor for some terrible disease, even if that risk factor is family history of bad diseases. Get over it, Happy. Smoking does not kill you or make you seriously ill in a few years, it takes decades in most cases, if it does anything at all.
Next thing, you'll be congratulating Fat Doctor's employer for canning her because she's obviously a burden on her employer.
Let's just give a huge halleluia that Happy chose to be a hospitalist instead of opening his own clinic because that clinic would fail in a heartbeat with these sorts of goofy business practices.
You claim to appreciate her contributions, yet still state that she costs her employer more than she would if she didn't smoke. You are wrong.
You appear not to realize that the words "on average" cannot be reduced to individuals. And Lab gal just called Bullshit on you.
Individual outcomes are pooled into statistical models to make decisions as to the probability that the data represents a true cause and effect relationship.
To say that "on average cannot" be reduced to individuals is correct. Nor should it be.
If a corporation is buying insurance in bulk for it's members, as a benefit, not an entitlement, then the strength in numbers means that on average, smokers cost them more. It doesn't matter if one individual costs less. The statistical average says it's more. Will some smokers cost less and have greater benefit to the corporation? Yes, they will.
So, should a corporation have a right, as a benefit, to determine how much of a benefit they will offer, and under what circumstances, assuming no laws are broken.
Yes, they should. If that means charging smokers more or not offering insurance that covers smokers, that is entirely within their right. And makes economic sense.
However, I save a lot of lives, pick up weird stuff left and right, save doctors' asses, and can crack a pretty good joke too. I also don't expect to croak any time soon. Maybe people are more to a company than a collection of illnesses and bad habits?
Really, group health insurance rates go up only with multiple catastrophic claims. We had this happen at our job when people kept getting terminal cancer early in life and dying on us. People who didn't smoke and were damn good employees too.
She was fabulous. Clients could relate to her. People would call to complain about smoking restrictions and she would be able to empathize and diffuse situations in a way that was magical.
While I understand the desire to hire non-smokers; I wouldn't rule out someone on their smoking status alone.
Smoking is an easy activity to go after in this way, but the broader principle here seems just awful--lots of your non-work activities become legitimate grounds for either firing you or otherwise hassling you, and everyone becomes less free.
No doubt, this can be used to decrease total health care costs, and we've got some big health care cost problems to deal with. But:
a. The economic problems in healthcare are not primarily driven by smoking-related costs, as you can see by noticing that the problems have been getting worse as the fraction of smokers has been going down.
b. Neither I, not, I think, you want to actually live in a world where this is done widely, not just for smoking (neither of us are affected by that) but also for many other lifestyle choices: diet, exercise, reading habits, church attendance, sexual tastes, hobbies, etc.
Maybe I'm wrong, and you'd like to live in that world. I wouldn't, despite the fact that I'm pretty sure I'd win in financial terms (I'm a middle-aged Catholic father of three who doesn't smoke, rarely drinks, isn't doing drugs or chasing women or men, etc.). That world looks much less free, a much less pleasant and nice place to live, than the one we're in now.
To ignore the extra costs associated with smoking and pay them anyway means that eventually non smokers will lose the benefit as well and everyone loses.
Perhaps the solution is just to stop offering health insurance. To stop offering sick days. To stop offering paid leave.
That way if you smoke, you lose. And nobody else pays for it. How's that for a solution.
You appear to have very little understanding of the term "on average". I treat cancer patients I guarantee you my lung cancer patients eat up significantly more than 3,400 per year (that they surivive). I also guarantee you that their productivity is much, much less than your hypothetical worker from mythical freedonia. But that is not the point. The point is that smokers on average do cost emplyers than non-smokers. Personally, I favor the carrot approach rather than the stick. But the carrot doesn't always work.