The Happy Hospitalist - Latest Comments in http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

albatross — Thu, 19 Feb 2009 15:33:00 -0000

How much of your life would you like your employer (insurance company, government) to be checking up on to optimally incentivize you to minimize their costs?

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.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Penelope — Thu, 19 Feb 2009 01:09:00 -0000

I once knew an administrative assistant who worked for a public health tobacco-control team, who herself was a smoker.

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.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Frank Drackman — Tue, 17 Feb 2009 21:38:00 -0000

How much do Pole-Smokers cost? those High-Five drugs are pretty pricy...

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

scalpel — Tue, 17 Feb 2009 11:42:00 -0000

Having an Arabic name is a marker for someone possibly being a terrorist, so we probably shouldn't hire any of "them folks" either.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

kris — Tue, 17 Feb 2009 08:04:00 -0000

just as an aside, i noticed your statistics came from the cdc who as the great and wonderful oz have deemed me to be dehydrated for 12 hours because not even a covered drinking container is allowed at the nursing station and with a 20 minute lunch and pratically no breaks my shift stretches out like the sahara dessert..really nothing to do with your post but I do wonder about some of their data collection.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

scalpel — Tue, 17 Feb 2009 02:53:00 -0000

I'm not aware of any studies that suggest nicotine when taken only in the form of lozenges (Commit) or gum (Nicorette) adversely affects mortality, causes increased health expenditures, or increased use of sick days. I understand that cotinine is a convenient metabolite for which to test, but its use is still unfairly discriminatory.

I would suggest the carboxyhemoglobin test be used as an alternative in that situation.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

scalpel — Tue, 17 Feb 2009 00:02:00 -0000

The cotinine test is unfair to those who use other forms of nicotine (dip, chew, gum, lozenges).

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Anonymous — Mon, 16 Feb 2009 22:48:00 -0000

it may be illegal to discriminate on the basis of sex, but we all know that women make less than men in general in the same job. so if an employer can assume that a female employee will tend to be more absent (pregnancy leave, sick kids, etc) or not put in more time than the required 8-5 because they've got to go pick up the kids etc (not that I'm saying any of this is a good enough basis to pay women less), I don't see why employers can't pay smokers or any other person who could in the long run cost then more through absenteeism or medical bills less.
- female nonsmoker without kids

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Clinton — Mon, 16 Feb 2009 22:25:00 -0000

Here's an article that promotes smoking cessation as an Incentive rather than a Punishment.

http://content.nejm.org/cgi...

As a non-smoker, I'd be miffed if my co-workers got paid $400 to quit smoking though.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

kris — Mon, 16 Feb 2009 21:38:00 -0000

well mlp with the state of my 401 k am not sure i want to be centerian....btw I'm 57 with zero medical hx that watch my non smoking co-workers take the elevator because the stairs wind them (WTF)...am not saying it's a good thing and have tried to quit but always fall off the wagon. I also spent 17 years in a nursing home watching people linger and linger and linger. I am a little tired of being treated like I'm satan's scourge while watching the revolving door parade of obese people with chronic problems that could be easily remedied by weight loss but I have to take sensitivity courses about their "needs"....what a crock of political correctness. I don't smoke around children or other non smokers.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

MLP — Mon, 16 Feb 2009 17:19:00 -0000

HH
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

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Old MD Girl — Mon, 16 Feb 2009 16:23:00 -0000

Crankylitprof -- It's interesting that you suggest that in sarcasm. The year after the FMLA act was passed was the first year that women saw a relative decrease in their wages compared to men's in 30 years or some such, since women constitute the population most likely to take advantage of it. Not saying it was a bad act to pass, just that people (companies) respond to incentives.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

crankylitprof — Mon, 16 Feb 2009 14:15:00 -0000

Oh, can we pay moms less, as well?

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

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

kris — Mon, 16 Feb 2009 14:09:00 -0000

ismoke..not good but also have never cost my employee a nickel in off time...where do these statistics come from???...i bet the fibros cost employers a lot more and let's not even go there with people with excessibe bmis...jeez i'm hardworking and productive and hike frickin' mountains on my vacations.

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Rositta — Mon, 16 Feb 2009 14:06:00 -0000

Not hiring smokers is a slippery slope in my view. Next consideration should be given to anyone who consumes alcohol or is overweight. Hell, the health risks are just as high in that group if not higher. Or maybe people who use sleeping aids could be the list as well, heck they might not be wide awake on their job and get injured, just thinking...ciao

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Anonymous — Mon, 16 Feb 2009 12:03:00 -0000

Exact scenario from an episode of Boston Legal...

Re: http://thehappyhospitalist.blogspot.com/2009/02/is-it-ok-to-pay-smokers-less.html

Anonymous — Mon, 16 Feb 2009 11:30:00 -0000

Employers have been not hiring smokers and/or terminating smokers that don't quit for a few years now. Check out this article. I like your idea, but think federal action might be needed as smokers might declare discrimination. My state has a Clean Indoor Air Act, but one must still run the gauntlet of nicotine addicts upon entering buildings - there is a requirement to stand X feet away from building entrances, but distance varies by smoker.