Hey Dude, You’re Fired!

Should people who are overweight or who smoke (even if they never do it at work) be fired? Or never hired in the first place? As health care reform heats up, some are saying that those who choose unhealthy lifestyles should be barred from the workplace and also charged more for their health insurance.

In an exceptionally well-crafted piece, David Leonhardt, writing for New York Times Magazine, describes how we rely on health care professionals and pills to keep us healthy when, in fact, the primary determinants of our physical well-being are the choices we make. We eat bad stuff, we don’t move around, we get stressed out, and somehow life gets in the way of doing anything differently.

Whatever your ailment, a pill or a procedure will fix it. Yet the promise hasn’t been kept. For all the miracles that modern medicine really does perform, it is not the primary determinant of most people’s health. J. Michael McGinnis, a senior scholar at the Institute of Medicine, has estimated that only 10 percent of early deaths are the result of substandard medical care. About 20 percent stem from social and physical environments, and 30 percent from genetics. The biggest contributor, at 40 percent, is behavior.

Smokers are already being fired (and not hired). And it is possible that people who are overweight are already being discriminated against because they, as a group, earn less money than those who are svelte. Questions are even being raised about President Obama’s choice for Surgeon General. Dr. Regina Benjamin, despite her many accomplishments, is, well, full-figured. Does that make her a poor role model, especially given the current national push to curb obesity in our children?

Tony Newman writing for Alternet lays out the moral dilemma:

Like most people, I support campaigns to reduce smoking and obesity. I believe in public education campaigns and policies that offer help to people who are trying to quit smoking or unhealthy eating. Positive incentives like gym membership reimbursements, or cessation aids like the smoking patch or Nicorette gum, can be valuable aids to those who struggle with addiction. But by firing workers for smoking or being overweight — and penalizing them when it comes to their health care — we will be demonizing and marginalizing those to whom we should be reaching out.

Then there is the slippery slope. As Newman continues,

They fired smokers first. Now they are talking about not hiring obese people. Your personal struggle or lifestyle choice may be next!

Think about it. Maybe next will be those who own motorcycles or a gun, or people who drink socially or who like to jump out of planes or parasail or climb mountains. Then maybe those who drive an excessive number of miles, increasing the probability that they will get into an accident. Then maybe….on and on.

What do you think? On the one hand, anything you and I can do to improve our own health is actually helping our country. On the other hand, one of the hallmarks of a free society is our right to make decisions for ourselves, even hazardous ones.

End note: A small, sad irony. Those who smoke are more likely to die from lung cancer. This disease advances aggressively, thus actually contributing to cutting down a little on health care costs.