Michael Siegel has been monitoring employers’ attempts to refuse to employ smokers (most recently and previously) and has pointed out how this is quite clearly discrimination against a disfavored minority. Occasionally someone effectively admits this, though usually they claim that it is done to save on health care costs. Siegel points out that this rings quite hollow, given that no such discrimination is directed at people who have higher medical costs because they are overweight (or eat badly, do not exercise, or participate in risky recreation).
But what may be overlooked is that there are predictors of an employee’s health care costs that dwarf the increased costs of smoking, overweight, or biking. All else equal, a smoker consumes a bit more health care than a nonsmoker, but being parent or a 60-year-old imposes far greater costs.
(Note that smokers consuming more health care all else being equal — which is generally accepted though the evidence is less than indisputable – does not mean they are consuming more than their fair share. Even the highest plausible estimates for the extra costs are less than smokers pay in extra taxes, so they are more than paying their own way. Moreover, and more closely related to the present point, spending fewer years retired (i.e., consuming but not producing) saves society far greater resource costs — dying earlier is a bad thing in general, but it does save resources.)
A single smoker with no dependents, particularly a young male, will have a tiny fraction of the healthcare costs of a similar-age nonsmoker who has children or simply is married (if the spouse does not have separate coverage from another source). The point is so important that it bears repeating: Having a child creates so many times more medical costs (to say nothing of other resource consumption) than choosing to smoke that complaints about the costs created by smokers, but ignoring the costs created by parents, can be explained only by a desire to discriminate.
Setting aside family coverage, a young female nonsmoker is more expensive than a young male smoker: Young men consume very little medical care, while pregnancy and childbirth are expensive. This reverses as we age and men suffer most of the diseases of aging on average a few years earlier than women. And, of course, the aging itself is the greatest predictor of one’s disease risks. To put that in the only terms that some people seem to care about, aging causes more spending on medical bills; just a few years of age adds more cost than smoking status. (With a bit of research, we could figure calculate the break-even point – if anyone is interested in collaborating on that, please let me know.) These observations do not even consider the costs of people with chronic diseases or genetic dispositions for expensive problems.
So if employers were genuinely worried about healthcare costs – rather than merely wanting to discriminate against smokers – they would not only treat obese people the same as they treat smokers, but they would make even more effort to avoid hiring people with young families (or simply would not offer dependent coverage — that is an easy solution), would avoid young women in favor of men, but would avoid older men in favor of older women, and would avoid older employees in general. (They would also refuse to buy insurance that covered wasteful spending like the costs of women having far too many mammograms, and hire people with pre-existing conditions, but those are different stories.) Taking these actions would dwarf the medical/insurance savings from not hiring smokers.
Of course, many employers try to quietly skew their employee population in exactly these directions, but they are appropriately ashamed about it such that they do not proudly declare they are doing it. Indeed, some of what is disturbing about the employment discrimination against smokers is the undertone of glee that seems to be present when a policy is announced. If it seemed like it was done with reluctance and a heavy heart it might be easier to believe that it was in no way motivated by a desire to harm people who they think deserve to be treated badly.
Of course, part of the problem is the nutty American system of having healthcare paid for by employers, thereby distorting the labor market in all sorts of ways. If it were not for that, American companies would be much more competitive, and employers would not be able to rationalize discrimination based on healthcare costs.
Carl V. Phillips