Light Up at Home, Lose Your Job

I previously <a href="http://hcrenewal.blogspot.com/2005/01/employers-vs-employees-control-of.html">posted</a> on some fundamental confusions caused by having employers pay directly for their employees health insurance. One was employers thinking that such payments entitle them to control their employees' health-related behavior, even off the job.<br />The <a href="http://www.detnews.com/2005/business/0501/27/A01-71823.htm">Detroit News just reported</a> that Weyco, ironically a medical benefits adminstration firm, fired four workers because they refused to be tested to see if they were smoking during off hours. The company already had stopped hiring smokers, and fined workers who continued to smoke. Weyco President Howard Weyers said his motivation included "saving money on the company's own insurance claims," <a href="http://olympics.reuters.com/newsArticle.jhtml?type=healthNews&storyID=7440773">according to Reuters</a>. An <a href="http://www.timesdispatch.com/servlet/Satellite?pagename=RTD%2FMGArticle%2FRTD_BasicArticle&c=MGArticle&cid=1031780483132&path=!news!columnists&s=1045855935174">editorialist also quoted </a>him as saying, "I don't want to pay for the results of smoking." Next on his agenda, again according to Reuters, is to "tell fat workers to lose weight or else."<br />The trend is spreading locally in Michigan, as Kalamazoo Community College is refusing to hire smokers to "reduce health care claims by 10 percent," per Sandy Bohnet, its Vice President for Human Resources.<br />The federal tax laws allow companies, but not individuals to deduct health insurance payments, so employers take money that could have added to employees' salaries to pay directly for their health insurance. Because they "pay" for employees' health insurance, some employers now seem to think they own their employees' bodies.<br />As a physician, I am no fan of smoking, but firing employees just because they smoke (off the job) just adds insult to injury. Of course, more rational tax laws could let individuals could make their own decisions about health insurance and health-related behavior, and be the ones responsible for their actions.

Light Up at Home, Lose Your Job

I previously posted on some fundamental confusions caused by having employers pay directly for their employees health insurance. One was employers thinking that such payments entitle them to control t…

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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.<br />One example is an argument that was distributed over two other health care blogs. <a href="http://medrants.com/archives/2005/01/02/a-comment/">Medical Rants</a> included a post from <a href="http://www.joepaduda.com/">Managed Care Matters </a>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 href="http://www.medrants.com/wp-comments-popup.php?p=2223&c=1">A few comments </a>made this point more eloquently.<br />A more fundamental confusion appears in <a href="http://detnews.com/2005/editorial/0501/07/D08-53788.htm">a story out of Detroit</a>. 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."

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 …

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