Employers are desperate about health care costs. Some are dropping health insurance altogether. Some are making employees put more “skin in the game” with increased deductibles. And some are starting to make employees pay for bad health habits.
A Harris poll reported in the Wall Street Journal in October showed that a majority believe that employers should not make employees who smoke, are seriously overweight, or do not exercise, pay more for their health insurance,
But starting next month, the Tribune Company in Chicago will charge employees who smoke $100/month. And the Kellogg Company is raising the premium for non union employees $360 for those who decline to take a health risk assessment. Other companies will follow their lead.
How ethical are programs like these?
I believe for a behavior like smoking that, while addictive, is potentially controllable, charging a small fee is ethically justifiable. The fee should be modest at the start. The aim is to attract attention and make the point that smoking doesn’t just harm ourselves – it taxes others by the health costs we generate. For that reason, the fee should be used to offset overall insurance costs. The $100/month the Tribune Company plans to charge would be punitive for most employees and seems too high. But the Tribune has addressed this by waiving the fee for employees who complete a smoking cessation course.
A teamster official who works for the Chicago Tribune asked “What are you going to do next? Say a guy who has history of heart disease has to pay more? Where’s it going to stop?” This is the right question. Charging more for people who are sick is not justifiable. But charging for a modifiable habit that contributes to higher costs for the whole group is.
We Americans worship financial fixes. What the Tribune and Kellogg are doing is justifiable if thought of as part of a broad attempt to help us recognize that we will only tame runaway health costs if we pull together as a population and self-prescribe some painful medications. A carefully planned charge for bad health habits can play a small part in the large educative process we need to carry out.