Monday, November 8, 2010

On Not Hiring Smokers

Five days ago I wrote a post defending the new Massachusetts Hospital Association policy decision not to hire tobacco users.

I usually agree with the editorial page of the reliably liberal Boston Globe. But today's editorial about the MHA policy gets things backwards. Here's the editorial, with my own editorial comments interlaced in bold italics:
Don't puff, don't tell?

IF THE country’s most brilliant expert on computerizing medical records came for a job interview at the Massachusetts Hospital Association with Marlboros in her pocket, she wouldn’t get the job. Neither would President Obama. Or House Speaker-to-be John Boehner. As of January 1, the organization that represents the state’s hospitals will no longer hire smokers for its 45-person workforce.

As easy as it is to sympathize with the motivation behind this policy, it is deeply — and unconscionably — intrusive into workers’ private lives. An employer like the hospital association should not set requirements that have nothing to do with an applicant’s ability to meet the demands of the position.

The word "unconscionable" is way too strong here. The Globe could see the policy as wrong without seeing it as "unconscionable," which is variably defined as "not guided or controlled by conscience," "unusually harsh and shocking to the conscience," or "unscrupulous or unprincipled." I don't understand what drove this editorial hissy fit.

On that score, the state was right in the 1990s to start prohibiting smokers from joining police and fire departments on the grounds that their habits would eventually make them physically unable to do their job. If the Globe really means what it says here, it should apply the same policy to its own employees - at least to those who do physically demanding work. No one wants to have to rely on a wheezer in an emergency. But there is no such reason for the hospital group, a lobbying and training operation, to reject a candidate who, at home, likes to light up.

As much as I want to see smoking eradicated, if the state's policy decision was based on a prediction that smoking "would eventually make [police officers and firefighters] physically unable to do their job, it was unnecessary. Employees who can't do their jobs don't get to keep the jobs. Perhaps the state anticipated having to pay disability pensions to smokers and wanted to avoid that future expense. This would be a reasonable business concern, but if it was the rationale for the policy it should have been acknowledged so that it could have been debated openly.

“We want a role model,’’ said association president Lynn Nicholas. This is a justifiable rationale. If I was the best qualified applicant for director of the Big Sister Association or the National Association for the Advancement of Colored People, we wouldn't, and shouldn't, fault those organizations for not hiring a Caucasian male! She notes that smoking costs the Massachusetts economy $6 billion a year in health costs and lost productivity. The diseases that tobacco causes or worsens are far and away the most preventable and take the greatest toll in lives. Nicholas believes that if more employers adopted her policy it could be the factor that keeps young people from taking their first cigarette.

Nicholas is not moved by the fact that two of the country’s most powerful elected officials — Obama and Boehner — are smokers. “[Obama] wouldn’t be a good fit for my organization,’’ she says, “when someone else who is equally qualified would.’’ With all the challenges facing the state’s hospitals as they deal with public demands for reduced health costs, the association should not be turning away highly skilled staffers who happen to be nicotine-addicted.
Nicholas is correct that "if more employers adopted her policy it could be the factor that keeps young people from taking their first cigarette." But the MHA policy shouldn't be generalized. Using access to employment as a primary approach to preventing tobacco use would be a bad policy, though not as "unconscionable" as allowing the large numbers of deaths, substantial disability, and huge drain on public resources, that tobacco causes. Continued increase in tobacco taxes, continued regulations to prevent second hand smoke exposure, and selective "role model" driven policies like the one the MHA is instituting, is the way to do.

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