Medical care costs are rising. There is also a trend recently for employers to be more concerned about the habits of their employees. Monitoring behavior that is perceived as "risky" is nothing new. I can remember one of the first times I was asked whether I smoked. It was on a life insurance policy application that I completed in college.
They also asked me if I was involved in skydiving. It did not strike me then that this insurance company apparently saw these two activities of similar interest, along with alcohol use. These perceptions are finding their way into employment decisions though, and there is a growing debate as to whether employers should be allowed to make employment decisions based on their perceptions of risk and cost associated with a prospective employee's habits.
According to the Unites States Parachute Association, 19 people died in skydiving accidents in 2012, out of roughly 3.1 million jumps. This represents a great decrease from the 43 people who died each year in the 1970s. While the actual volume of deaths has been decreasing in recent years, we have not reached the baseline of 14 fatalities that was recorded in the first year of record-keeping, 1961. I reflect on this because I did sign up to jump out of plane once. I can hear my father now,"why would anyone jump out of a perfectly good airplane." I got my money back.
According to the Centers for Disease Control (CDC) smoking causes cancer, heart disease, stroke, and lung diseases. They estimate that smoking causes more than 5 millions deaths annually. Smoking is a little more dangerous than skydiving. There is expense involved also. The CDC estimates that actual smoking costs $193 billion ($193,000,000,000) each year in lost productivity ($97 billion) and actual medical cost ($96 billion). They claim that second-hand smoke adds another $10 billion. There are about 315,637,919 people living in the United States. That $203 billion is costing each American about $646.00 annually.
Obesity is harder to estimate. Fat is accused of death and other health complications, but does not directly kill. So, according to the U.S. National Library of Medicine, "estimates of deaths attributable to obesity in the United States rely on
estimates from epidemiological cohorts of the relative risk of mortality
associated with obesity." They concede that it is difficult to determine the death rates from obesity with any real accuracy. However, studies have opined on the cost of obesity. CNN cites a figure of another $147 to $210 billion for adult obesity. That is another to $468.28 to $669.00 for each of us.
So each American is underwriting the cost of about $1,100 to $1,300 per year for treatment of smoking and obesity related medical care.
Obesity has also been linked to increased costs of workers' compensation claims. A 2010 NCCI study concluded "there are systematic differences in the outcomes for obese and non-obese claimants with comparable demographic characteristics. The study also concludes that there is greater risk that injuries will create permanent disabilities if the injured worker is obese." NCCI also lists smoking as a "risk factor" in injury claims. Both are viewed as a valid consideration in risk management or risk avoidance.
Recently, companies have found their way to publicity or with pronouncements on hiring practices. The University of Pennsylvania recently announced recently that they will not hire smokers. Some employers are even screening for nicotine, like other drugs, in their hiring process. There is an apparent trend in this direction. There are some who question whether there is any point in such a policy, as someone could cease smoking long enough to get hired and then resume smoking once an employee. Likewise, one could crash diet to achieve a particular weight or body mass and then, after being hired, return to their former weight or body mass.
In addition to UPA, other hospitals have taken the anti-smoking approach. Companies adopting these practices cite the high cost of health care associated with such habits in their employees. I have not found any legal authorities that argue this new practice is illegal, unless smoking is protected specifically by state law. I found a few that have such laws. I could find only one state, Michigan, that protects the obese from discrimination in hiring in a general way. However, it is arguable that obesity could be protected by the Americans with Disability Act. The future of these practices regarding the smokers and the obese is therefore not certain.
What is clear is that popular opinion is against the practice of denying employment based on obesity or smoking. Many believe that it is inappropriate for an employer to even ask about health risk issues in the hiring process.
We know that medical costs will continue to rise. We will see whether legislatures will act to require employers to hire employees they perceive to be high risk. This will be a different debate than previous discrimination debates. Many, perhaps most, Americans view both smoking and obesity as individual choices people make, which they see as different from inherent characteristics such as gender, race, and national origin. Anyone can choose not to skydive. Whether smoking and obesity are similarly "choices" and whether discrimination upon "choices" will be condoned are interesting questions. Will employers be allowed to avoid the direct medical costs and the productivity costs associated with these perceived risky behaviors?
This will be a complex issue. As employers seek lower health premiums and greater productivity in an increasingly competitive job market, and as the number of obese Americans continues to grow, there will be more debate about whether obesity, or smoking, is preventable, whether these behaviors are choices or truths, and whether such behaviors will be protected by the law. Already, some advocates are arguing that these "behaviors" are more prevalent among the poor. They argue that discrimination on these behaviors will at least have a disparate impact on the poor and that this discrimination is inappropriate.
