HEALTH :: FEBRUARY 16, 2005

One of my loyal readers writes to ask for my opinion on the Weyco anti-smoking flap. Being in the same boat as the Car Talk guys on NPR (“We can’t afford to lose another listener!”), I hasten to oblige.

Okemos-based Weyco, Inc. has recently fired four employees for failing to quit smoking. My take on this: 1) It is unethical; 2) for something unethical, it was done in a very nice way; and 3) this shows again why we need national health insurance.

Point One: I don’t believe that it is the proper role of the employer to look out for the health of the individual employee in a way that intrudes this much into a person’s private life. The employer can protect other employees from second-hand smoke by making the workplace smoke free.

There’s some evidence that people who attend church every Sunday are healthier than those who don’t. I doubt anyone would approve of a company requiring church-going as a condition of employment. So the mere fact that smoking is unhealthy does not, in my opinion, justify the company’s stance.

Point Two: Suppose, for purposes of argument, we admit that it was O.K. to have this company policy. The question then becomes: How well or how badly did Weyco implement the policy?

So far as I was able to learn, they did so in an exemplary fashion. They gave their employees plenty of notice that the new rule was coming. They offered to pay for a variety of anti-smoking measures. In general, they were very supportive and compassionate and took into account how difficult it can be for a smoker to quit. (We docs understand that if you have two addicts — one taking crack cocaine, the other smoking cigarettes — and the goal is to break the addiction cycle, by all means send us the crack-head. Our success rate will be much higher.)

On one hand, I think it is unethical for the employer to intrude into the employee’s private life; but on the other hand, I strongly endorse workplace wellness programs so long as they are voluntary. Right now the workplace is a vastly under-utilized site for possible wellness efforts. (Yeah, I know, the silly boss thinks you came there to work.) People are reliably there most weekdays, and the supportive effect of working on health issues alongside your co-workers is often a real plus.

So now we struggle on to Point Three. I have been ragging about national health insurance in enough previous columns that you probably don’t want another lecture. But I would simply add here that the Weyco flap shows us just one more time how silly it is that in the United States, we ever came to imagine such a tight connection between getting health insurance and working in one place or another.

The vast majority of the roughly 45 million (and growing) uninsured in the U.S. are employed workers and their dependents. It’s luck of the draw whether you work in a place that provides insurance benefits or one that doesn’t. Bill Clinton tried to dissociate health insurance from work, while retaining the generally private, for-profit nature of the health insurance industry. The free-market advocates showed their gratitude by shooting down his plan in flames. Now George Bush would like to dissociate health insurance from work by making all insurance into private “ownership” savings accounts, the problems with which I mentioned in a previous column. Some day, perhaps before I die, we will get it right.