published Sunday, January 24th, 2010

Memorial's smoking stand

Memorial Hospital's decision to stop hiring workers who smoke beginning February 1 can be broadly justified as a symbolic standard for a health-care provider. Yet its challenge to traditional standards of fair treatment for employees and job applicants is a bit more tricky. Ultimately it leads to question of whether employers should attempt to regulate the private, legal, off-premises, life-style behaviors of their employees, and, if so, where to draw the line.

Memorial Hospital's decision was not based -- as many might suppose -- on potential savings in health-insurance costs, said Brad Pope, vice president of human resources. Rather, it was intended to reflect the hospital's commitment to health. (Tobacco use is already forbidden on the entire Memorial campus, and current employees who smoke will not come under the ban.)

"Like it or not, what's proven is that tobacco is the most preventable cause of death and disability in the United States," he said. "I think the Chattanooga and surrounding communities should expect this from Memorial."

Use of tobacco is, indeed, the most readily apparent example of an external, deliberately selected behavior that is devastating to an individual's health. It also is seen as a risk that individuals should be able to control or quit, however strong the addiction.

People who choose to smoke risk not only their own health; their second-hand smoke also poses a health risks for those around them. Smokers willingly, if negligently, run a high risk of several types of cancer and pulmonary disease, and their higher, tobacco-related, health care costs often falls heavily on insurance costs to the government (through Medicare and Medicaid) or a user's employer and colleagues, whose insurance premiums bear the cost-sharing burden.

Thus it has become easy for non-smoking colleagues and their employers to justify a demand for higher insurance premiums from their tobacco-using colleagues, or, more obliquely, to provide discounted premiums for those who do not smoke.

Tennessee's businesses and government agencies, moreover, have more reason than some other states to actively discourage tobacco use. Tennessee's smoking rates are higher than in many states. Tennessee's rate was 23.1 percent in 2008; that's significantly higher, for example, than the 19.5 percent rate in Georgia. Tennessee's youth smoking rates also are going up, rather than down.

Still, tobacco is hardly the only risky behavior that individuals, in many cases, could consciously avoid to safeguard their health and to lower potential health-care costs to themselves, their employers and to the general economy. Soaring rates of obesity, a precursor to type-2 diabetes, is perhaps the next best example.

With an adult obesity rate of 30.2 percent, Tennessee is the fourth-most obese state in the nation, according the most recent annual report by the Trust for America's Health. Worse, the obesity rate for children in this state is a shocking 36.5 percent. In fact, health care officials now predict that one of every three children born after 2000 will be obese and at risk of type-2 diabetes.

At stake in the near future is both the health-care costs of obesity, which ranges widely from diabetes to heart and vascular disease and a range of other ailments, and the resulting sickness, disability and loss of economic productivity. In fact, obesity rates now portend significantly higher economic and health care costs, and a substantial drag on our general prosperity. Coupled with our lamentably low education rates, the downward trend of our health indices is yet another crippling blow to the state's future.

Yet other risky behaviors abound. Many people, for example, drink too much alcohol. Others ride motorcycles, which produce a high incidence of catastrophic brain injuries and exorbitant medical costs that is often shifted to the public. One could argue that rock-climbing, hang-gliding, sky-diving, and bicycle, ATV and horse-back riding are needlessly risky.

It is imminently fair to ban smoking and other tobacco use at work, and to charge differentiated health insurance premiums. But if it is fair to discriminate against smokers by barring them from jobs on the grounds of a commitment to health, why stop there. Or better yet, why begin down that slippery slope.

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This is a very well expressed opinion. I find myself grappling with the same issues when considering this move by Memorial. It is difficult to defend smoking. It is a disgusting, unhealthy habit. While I try to avoid "slippery slope" arguments, it does make me wonder what could be banned next.

January 24, 2010 at 7:38 a.m.
AndrewLohr said...

In your list of risky behaviors, what about sexual behavior? (What was your motive for not mentioning it?) Of course as a Christian I approve of making love inside holy marriage, and disapprove of all other sexual activity, but even statistically you overlooked something big: illicit sex kills thousands a year, and sickens millions, in this country alone, and sex like smoking is to some extent a choice, however hard to change. (People who claim genes determine sexual [mis]behavior overlook the biological fact that nonbreeding sexual behaviors would, genetically, make themselves extinct. People who feel their identity challenged by God's command to repent of sexual sins are themselves challenging the sexual identity of those who do repent; ex-gays challenge the sexual identity of gays, AND vice versa.) Of course, like most sins sexual sins can be repented of and forgiven in Christ Jesus. And to keep things in perspective, what about government behavior? Atheists Stalin and Mao, and nominal Christian Hitler (he only went to church once, for Pilsudski's funeral, in the last 25 years of his life), killed tens of millions each, making smoking look safe. (The book DEATH BY GOVERNMENT gives statistics.) Government interference, even short of slaughter, is a "slippery slope." If someone sued Memorial, should the government get involved, or throw the case out? I'd say throw it out; there are other hospitals in town, and Memorial's self-inflicted loss of a potential skilled employee can be their gain. If it were the only hospital within 100 miles in central Alaska, maybe; within two miles of other hospitals, why bother? Same for other discriminations by private entities, as long as other accomodations are handy and the discrimination is openly stated. (Would the Times hire me as a columnist, or would it discriminate against a fundamentalist? :) And if smoking is risky, abortion kills on purpose (and THAT the government should indeed punish); and smoking may be addictive, but the murder of little babies for the convenience of grownups bills itself as "choice." And just as there are ex-smokers, there are ex-abortionists, including "Roe." Jesus' tent is that big. I think it's big enough to include Memorial's policy and also different policies.

January 24, 2010 at 9:27 a.m.
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