Discrimination is good. Just ask the managers of the Providence Alaska Medical Center in Alaska's largest city. They're trumpeting a decision to ban the hiring of people who smoke.
"We believe that by doing this move, to where we are no longer going to hire cigarettes online users, that we are sending a very clear message into the community that we are not only the leaders in health care, but we're really the leaders in health," Tammy Green, director of health management services for Providence Health & Services Alaska, told the Anchorage Daily News.
Good for Providence. Maybe not so good for you, but more on this later.
Let's talk about smoking cigarettes first. Everyone knows smoking cigarettes is bad. Everyone has heard about how it "causes'' cancer, although really it doesn't. If it did, everyone who smoked would get cancer. They don't.
There is no direct cause-and-effect relationship between smoking cigarettes and cancer, and the scientists who make claims as to how smoking cigarettes "causes'' cancer should be ashamed of themselves. The sad truth is we really don't know what "causes'' cancer.
We do know that certain substances predispose one to cancer, and smoking cigarettes is at the top of the list, given that most Americans aren't heavily exposed to aflotoxin, a nasty carcinogen naturally produced by the fungus Aspergillus which contaminates nuts and grains in much of the third world. Many scientists consider aflotoxin the deadliest carcinogen.
Exposure to large doses of aflotoxin (some cancers appear to be dose related) will seriously up your odds of getting liver cancer. Smoking, on the other hand, will significantly up your odds of not only getting lung cancer, but coronary heart disease, emphysema and more. The Centers for Disease Control has a whole list of diseases associated with smoking cigarettes and the use of cigarettes products.
Excuse the federal agency for claiming smoking cigarettes, chewing or nicotine use in general "causes'' any of those diseases. There is a whole lot of spin around the smoking cigarettes issue in this country today and even scientists get caught up in it. America, the great land of individual freedoms, can't quite bring itself to ban discount cigarette online as unsafe. So government officials and some business leaders have resorted to different tactics. The prevailing strategies are to boost cigarette taxes so high people can't afford them, scare smokers away from their fags, or ostracize them.
The latter does not seem to have worked so well. It might have had the opposite affect. Ostracizing smokers seems in some cases to have forced them to bond. The first small fraternities of smokers developed in inter-office smoking cigarettes rooms, which were eventually banned in the big fear over second-hand smoke. Personally, there are a lot of carcinogens out there I worry about more than second-hand smoke, but that didn't stop government from pushing smokers out of the office smoking cigarettes room into the cold.
Whether making smokers uncomfortable did any more to stop people from smoking cigarettes is debatable. I've known people who tried to quit and gave up because they missed the friends they'd developed in meetings at the designated smoking cigarettes spot. And while the price tag may have limited how much people smoke, doesn't seem to have stopped them either.
So government is amping up new efforts to scare people away from smoking cigarettes or chewing. New, more threatening warnings went on cheap cigarettes products in September.
It seems only a matter of time before the front of a cigarette pack simply says: "Smoke this; you die!" But scaring people never seems to work. The country tried for years to scare people into wearing their seat belts. Government finally gave up and settled on "Click it or ticket,'' the threat of a ticket apparently being more intimidating to Americans than the threat of death in a car accident.
When the going gets tough, the tough write new laws restricting individual freedoms, or resort to playing dirty in the market place.
Providence has decided on the latter tactic. It has given up on trying to reform smokers. It says it's going to free its facilities of them the easy way. The company is going to test new employees for nicotine and ban the hiring of anyone who tests positive, be it from smoking cigarettes, chewing or even being on the nicotine patch in an effort to quit smoking cigarettes or chewing.
Providence says its executive team came to this decision after length consideration. Providence says it’s all about improving employee health and saving money on health care costs. You can dismiss the former claim as nothing but a bunch of PR hogwash. Banning the hiring of smokers might ensure Providence has, in general, a healthier workforce, but it's going to do nothing to improve employee health. If Providence really wanted to improve employee health, it might do something like institute a mandatory employee fitness program or, at the very least, ban employees for sitting for more than a few hours at a time.
Yes, strangely enough, even sitting has now been linked to cancer. Sitting for lengthy periods of time has been shown to be another of those things -- like smoking cigarettes -- that predisposes people to cancer.
"Women and men who both sat more and were less physically active were 94 percent and 48 percent more likely, respectively, to die compared with those who reported sitting the least and being most active,'' concluded a recent study done for the American Cancer Society. Ninety-four percent more likely to die is a not a good thing.
Ping me when the first business designates an anti-cancer monitor to roam the offices making sure everyone gets out of their chairs and moves around for 10 minutes or so every few hours to reduce their risks of getting cancer. I don't expect to be getting a lot of messages. Plenty of businesses talk about "employee health,'' but not all that many do much about employee health. When my old employer -- the Anchorage Daily News -- started downsizing and cost cutting to try to survive in a changing market place, one of the first things to go was the employee exercise room.
Business in this country isn't all that concerned about the economics of the long term. Business in this country lives in the moment. Whether Suzie is alive a month from now isn't nearly as important as whether Suzie is in the office today busy typing away and not at the doctor's office again boosting the cost of what the company has to pay for health insurance. Non-smokers miss work less than smokers, who cost, again according to the CDC, employers an extra $3,400 a year on average.
Getting rid of employees who smoke cigarettes is a good business decision. In this case, it is clearly good for Providence but, as noted above, maybe not so good for you as a taxpaying American citizen.
The issue of smoking cigarettes and health care is, it turns out, a complex one. A number of studies have concluded that while smokers cost their employers more (at least if the smoker can find a job) they end up costing the taxpayer less. As one study noted, "If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cigarettes cessation would produce a net increase in health care costs."
The reason for this is simple. Smokers die sooner. The average 30-year-old smoker is reported to have a life expectancy of 65 in this country. The average 30-year-old non-smoker, on the other hand, is expected to live to 83. If you've been paying attention to this country's fiscal crisis, you probably know that age 65 is sort of a magic number. It is the retirement age in America, and the age at which government retirement and health-care benefits paid to the country's aging population explode.
Because Americans are living longer, and because the nation now supports its seniors with greater benefits than in the past, there are those worrying the whole damn country could drown in a sea of elder-care red ink.
Against that backdrop, one could almost argue smoking cigarettes is, in a societal sense, good. The people who do it obviously enjoy it, and they die younger, saving us all a lot of money. Look, I know those words sound harsh. And I certainly don't want anyone -- smoker or not -- to die. But there is a little reality we all need to face:
We are all going to die. Most of us, myself included, would prefer to do it later rather than sooner, which brings me to a little personal problem with what Providence has done. And, no, it has nothing to do with religion, though one would think that a medical institution founded by the Catholic good Sisters of Providence would be more into trying to save smokers than banish them.
I know folks who smoke. Most of them are good people. A few of them are extremely talented. Providence makes me feel sorry for smokers, but like most Americans, I really don't care about them. Like most Americans, I care mainly about me. And at that very basic level is where Providence's action troubles me. Why?
Because here is what I want to find at Providence or any other hospital in Alaska: The very best doctor available.
If I'm badly hurt in an accident, and end up in the emergency room at Providence -- a situation in which I have no control over what physician is going to treat me -- I want to be seen by the best trauma doctor that can be recruited to come living in cold, dark, far-off Alaska. I'm not interested in the best trauma doctor who doesn't smoke, or the best trauma doctor who is white, or the best trauma doctor who is Jewish, or the best trauma doctor who can run a sub-40 minute 10K road race.
I want the best trauma doctor available, period. I really don't care what he does in his private life, short of murdering or torturing people. I really don't care whether he is healthy as an ox or sickly, as long as he has no contagious diseases. I really don't care if he's a giant or a dwarf, ugly or TV beautiful. All I care is that he is good at what he does. And given that concern, I don't like Providence arbitrarily limiting the pool of job applicants -- or in the worst-case scenario refusing to hire the best person -- based on some arbitrary and discriminatory rule dictating how the company has decided people should live their lives.
And yes, the smoking cigarettes ban is discriminatory. A stenographer for the local newspaper might dutifully write down that "Providence executives considered whether the change would be in any way discriminatory and found that it wouldn't be,'' but the reality is that what Providence executives discovered is that their action isn't "legally discriminatory.'' In other words, they're not going to get hauled into court for discriminating against smokers the way they might if they suddenly decided to ban the hiring of the obese, who cost businesses even more than smokers.
Medical spending for obesity-related disease was estimated at $147 billion in 2008, about 6 percent of all health care spending costs, according to David S. Martin, the senior medical producer for CNN.
Smoking costs were pegged at $96 billion. An estimated 21 percent of Americans are addicted to cigarettes. An estimated 32 percent are obese. If you do the math there, you'll see that on a per capita basis the fat people are costing the health care system just a tad more than the filthy smokers.
The CDC is so concerned about the health-care costs of obesity that it provides an on-line obesity-cost calculator for businesses. "The calculator," the website says, "reports obesity-attributable costs among employees, both medical (for those employees with health benefits) and the value of absenteeism. All costs are assumed to be borne by employers. In reality these costs can be passed on to employees through sharing of health insurance premiums and possibly adjustments to wages."
CDC calls its program "LEAN Works!'' and says that while it "helps employers estimate the cost of obesity to their businesses. CDC’s LEAN Works! should not be used to promote discriminatory practices such as considering weight in hiring or other personnel decisions. Weight discrimination is a serious issue and evidence indicates that it occurs in the work place."
There is, you see, discrimination and then there is DISCRIMINATION!
Discrimination against smokers? OK!
Discrimination against the obese? Not OK!
Or at least not OK for now. Who knows about tomorrow?
A reasonable person might wonder if maybe there isn't a better way. How about just calculating the extra cost in health care premiums for smokers and the obese, and then sending each of them a monthly bill to remind them it might be a good idea to change their habits. It might actually be possible to help people live healthier lives -- if, of course, the goal is really to help them live healthier lives. If, on the other hand, the goal is to save money, Providence might find some subtle, legal way to get rid of the obese folk, too.
Their absence would make the medical facility look healthier because, I've got to confess, when I'm at Providence wandering around, I can't tell the smokers from the non-smokers.
There's no one sending me any conflicting messages that maybe smoking cigarettes is OK. But there are plenty of big bodies sending the message that being overweight is fine. It's a message I would prefer hospitals not send because the reality is that being overweight is not fine. It is an epidemic in this country.
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