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Volume 3 Number 5 February
11, 2005 |
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Snooping bosses How far into our personal lives should employers be
allowed to probe? While the notion of business and political ethics seems as if it's quickly becoming some macabre joke, I was distracted last week by a small news story about a company that fired several of its employees for refusing to take a test that would show whether the employees had used tobacco products. Some people saw the story as odd, but I was bothered by some much deeper implications. The company's rationale for forbidding its employees from smoking is that it has the potential to increase health-care costs for the company. By eliminating smoking as a health-care risk, the company claims it can save money. Although I've been known to succumb to the wiles of an occasional cigar, I don't consider myself a tobacco addict, or even a "smoker," with all that that implies. And while I think the tobacco companies have a lot to answer for in the way they produce and market their products, I'm pretty much of a libertarian (small "l") when it comes to letting people choose their own poison -- as long as they don't poison me in the process. With that disclaimer out of the way, I think the main lesson to be drawn here is that any national health-care system that makes employers, or more precisely corporations, the gatekeepers of health care is seriously flawed. The one and only obligation of corporations is to make money for their stockholders. When any other consideration -- including the health and welfare of employees -- interferes with that, profit will win out every time. That does not bode well for employees. But, for the sake of argument, let's just assume that this idiosyncratic health-care model of ours is the proper way to proceed. Is the company correct in its contention that smokers cost them more money than other employees and that the company is better off if people don't smoke? I've never been persuaded by the economic arguments against smoking. First, it's a given that people are better off if they don't smoke. I don't think we need to argue that, but people are also better off if they wear seatbelts, get regular exercise, avoid stress, reduce the fat in their diets, and a engage in a host of other behaviors that can positively affect health. The question is whether the economic impact on this particular company of smoking versus not smoking is great enough to warrant this intrusion into what people do on their own time. You don't have to look far or wide to find some figures that in any given year smokers consumer more in health-care resources because of smoking-related illness. Those figures are true, but a lot depends on how you interpret them. Simply to say that X number of people developed smoking-related illnesses and consumed Y dollars in resources in a given year doesn't tell the whole story. Let's consider twin brothers, Joe Blow and Moe Blow. They are identical twins and are raised under similar circumstances. After they leave home at 21, Joe Blow takes up smoking, Moe Blow abstains. Both lead fairly productive lives and stay relatively healthy -- although smoker Joe has a few more colds and respiratory infections than Moe -- until they are in their early 60s. During that time, Moe consumes about $10,000 in health care costs annually, and Joe, because of his minor smoking-related illnesses, consumes about $12,000. At the age of 63, smoker Joe contracts a smoking-related illness and stops being a productive (solely from an economic standpoint) citizen. During his first year of illness, he consumer $100,000 in health care costs and in the second year, $150,000 and finally dies. Non-smoker Moe lives on to the ripe old age of 85. However, as age sets in, he suffers normal age-related illnesses that require treatment. One of the problems in delaying mortality is that morbidity increases and becomes increasingly more expensive. Moe's health-care costs -- due to inflation and the age-related illnesses -- increase by 10 percent a year. Since 65 when he retired, Moe has been an economically non-productive citizen (meaning he didn't work and didn't contribute to the gross domestic product). At age 83, Moe's age-related conditions worsen to the point where he needs more care and his costs increase to $100,000. In the next year, he declines even further and dies, but not before racking up $150,000 in costs. So, let's do the math. Up until the age of 63, Joe consumes about $492,000 and Moe, $410,000. In the next two years, Joe consumes $250,000 and then dies. Moe, because of his age related illnesses, despite his being relatively health, consumer an ever-increasing amount, until he reaches an additional total of $511,500 at age 83. Then, in his final two years, he consumers another $250,000. Joe's total cost, measured over his lifetime, was $742,000. Moe's total cost was $1,171,500. Of that total, $761,500 was consumed after Moe had stopped being economically productive and had stopped contributing to the system. Looking at the averages, smoker Joe consumed a yearly average of $11,415 in health-care costs over his lifetime, and non-smoker Moe, a yearly average of $13,782. Of course, the actual numbers are fictional, but it's the model with which I'm concerned. We will all die, and with a decrease in early mortality and an increase in lingering morbidity, we will all consumer more in resources as we go on, and we will consume the greatest yearly amount in the last two years of life. Smokers, however, will generally die earlier. Not all smokers, however, will die in only two years. Some develop more lingering illnesses and become unproductive earlier. My intent is to show that the idea that all smokers will consume more in health care costs isn't necessarily true. The model is also confounded by other behaviors -- poor diet, lack of exercise, associating with other smokers, huddling on a rain-soaked sidewalk outside the office for 10 minutes every hour -- that can also have a negative effect on health. But let's assume (we're going farther and farther out on the limb with assumptions here) smokers consume more in health-care costs earlier. How likely is it that this company will feel the impact? As people change jobs with great frequency these days, it seems unlikely that the impact on this company would be severe enough to warrant a major intrusion into people's personal lives. But let's assume (now sawing off branch) that personal habits and their effect on health-insurance costs is a legitimate concern of the company. Why single out smoking? There are other personal off-the-job behaviors that can affect the health-care costs associated with any employee. Pregnancy, especially a complicated pregnancy, can have an effect. So, for example, could a couple that adopts a special needs child. Should these people be barred from employment also? And what about people who don't exercise regularly, whose diets leave a lot to be desired, who don't wear seatbelts, who manage stress poorly, or engage in any of a myriad of behaviors that have been proven to have a negative effect on health? How does the company deal with them? Why is smoking the only behavior worthy of getting someone fired? You could argue, I suppose, that some behaviors -- such as pregnancy or adoption -- have a great deal of social usefulness and so the company is willing to underwrite these risks. But that now leaves us in the unpalatable position of social utility being decided by corporate bean-counters whose main concern is ensuring that the corporation makes as much money as possible. Even so, companies don't (yet) put cameras inside your car to make sure that your seat belt is properly fastened at all times. If this whole thing seems unclear, it's because it is. We're sailing in uncharted waters on employer intrusion, which has been growing by leaps and bounds over the last few years. Because the surveillance technology is available, and people can profit from it, it's being sold as the solution to all problems. And we've bought into it. The biggest and boldest step onto the slippery slope came with the introduction of non-job related drug testing. Job-related drug testing would be to determine whether someone in a life- or health-safety related position was under the influence while on the job. That's hard to argue with, but it underwent mission creep until it included off-the-job testing, and then it crept even further with the practice of testing the off-the-job drug use of non-critical employees. As a writer, what difference would it make if I smoked (I don't) a marijuana cigarette on a Saturday night in the privacy of my own home? As far as my job performance, most likely nothing. I, and my job performance, may even benefit from being in a relaxed state for a few hours. "But it's illegal," I hear you say. "And we don't want any of our employees breaking the laws of this great country of ours." "Not so fast," I say. "I took a long weekend a couple of weeks ago to a country where smoking marijuana isn't illegal. I participated in a religious ceremony that used marijuana, and then I came home. I didn't break any laws in this country." The marijuana test, which will show up positive for 30 days after marijuana use, doesn't say when or where the person smoked it, and for most companies that use the test, a positive result is enough to get the person canned -- but the "illegal" justification doesn't necessarily hold. And even if it did, why isn't the company pursuing other off-the-job victimless crimes committed by employees -- especially where no arrest has taken place? Some people have been known to speed while driving. Should the company install "black boxes" in people's cars and fire those who exceed the speed limit? Should the company (as I suggested above) put cameras into the car to ensure that occupants wear their seat belts? Both speeding and lack of seatbelts (in some jurisdictions) are illegal and they pose a significant risk of costing more in health-care dollars, especially since the effects aren't as age-related as tobacco use. Few people become ill from tobacco after a year of use. Many people suffer severe injuries from speeding and non-use of seatbelts, even at a very young age. So, I could probably make a good argument that the company -- using either the cost argument or the legal argument -- would be more justified in monitoring driving practices than testing for smoking. The point is that we've allowed corporations to intrude deeply into our lives, and we seem to have done this without a murmur -- sometimes with a smile on our face. They will keep up the pressure and will intrude more deeply until we push back. They question is where we will draw the line. |
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© Copyright 2005 Carlton Vogt |