Employers' vs Employee's Control of Health Care

In the US, most employers provide employees health insurance benefits. The reasons for this have to do with history and tax law. In World War II, because of wage controls, employers could not bid for scarce employees by offering higher salaries, so they offered other benefits, such as health insurance, instead. Furthermore, employers can deduct employees' health care insurance from their income for tax purposes, while individuals cannot generally deduct what they pay for their own health insurance. This arrangement gives employers, rather than individuals, control over what health insurance options they can choose. It also can even further tilt the balance of power and control over health care to large organizations (large employers) and away from the individuals who actually need the care. Such large organizations may not always make decisions about health care that are best for their individual employees.
One example is an argument that was distributed over two other health care blogs. Medical Rants included a post from Managed Care Matters which argued that "the real issue employers have with health care costs is they have NO sense for their return on the investment. " Thus "what employers SHOULD be thinking about is the demonstrated ability of a health care provider to 'deliver' healthy, fully functional employees and families." Of course, it really is the patient who should be concerned about his or her health care provider's abilities. How a corporate benefits manager could figure out the performance of all employees' health care providers, and then sensibly figure out how to improve them, is unclear. A few comments made this point more eloquently.
A more fundamental confusion appears in a story out of Detroit. A local medical benefits administration company, Weyco, Inc. has apparently decided not to hire any new cigarette smokers, and to fire any current employees who refuse to quit. The rationale by the company president, "increasing health care costs were choking his business." I am a strong advocate of quitting smoking, but as the Detroit News editorialist wrote, punishing smoking employees by firing them has surely "gone too far."