If you smoke tobacco, you're not going to be hired for a job by the Baylor Health Care System. For that matter, you don't need to waste time filling out an employment application form at the Cleveland Clinic either. Both healthcare providers have made it clear that they will not accept smokers within their respective workforces.
In its editorial today, USA Today says this type of policy is wrong. The newspaper argues that employers like Baylor CEO Joel Allison and Cleveland Clinic CEO Toby Cosgrove (both members of the Healthcare Leadership Council) have every right to offer smoking cessation programs to their employees and even to make smokers pay more out of pocket for their workplace-provided health insurance. But, USA Today says, it is improper to penalize a job applicant for practicing a legal habit on their own time.
USA Today is wrong, and not just because of its nonsensical comparison of a voluntary activity like smoking to an individual's genetic makeup.
There's also a significant economic issue involved here. When an employer, particularly one who provides health coverage, hires an individual, they are assuming the burden of his or her healthcare costs. An individual may smoke on their own time, but the employer winds up footing much of the bill for the chronic illnesses associated with smoking. Should an employer be allowed to consider the increased health costs, absenteeism and loss of productivity associated with a voluntary, unhealthy behavior like smoking? It's hard to argue that they shouldn't.
And in an environment in which five percent of the population is responsible for 50 percent of our healthcare costs, this is a concern that goes well beyond Baylor and the Cleveland Clinic.
I know both Joel Allison and Toby Cosgrove. They are both gentlemen who have dedicated their lives and careers to providing better health to their fellow citizens. Their no-smoking policies are neither mean-spirited nor discriminatory. Rather, they are intended to make a vitally-needed statement about wellness and healthy living both within and outside the confines of their respective institutions.
If you've ever watched the movie "The Sixth Sense," you see what a talented director and writer can accomplish by withholding critical information from the audience. In that movie (and, no, I'm not going to spoil it if you haven't seen it), M. Night Shyamalan holds back an essential fact about Bruce Willis's main character until the very end of the film. When that fact is revealed, it changes the entire context of what we thought we knew about the story.
What works well, though, in the cinema isn't necessarily a sound methodology when it comes to public policy matters that affect lives. Transparency is public matters is virtually always a good thing, but when the practice of transparency reveals facts without context, it can be counterproductive.
Dr. Thomas Stossel, a professor of medicine at Harvard Medical School, discussed this issue in a Wall Street Journal op-ed this week, "Who Paid For Your Doctor's Bagel?" In his op-ed piece, he discusses the Physicians Payment Sunshine Act, a new law that will require medical innovation companies to disclose any transfer of value to physicians. The Centers for Medicare and Medicaid Services (CMS) has recently issued draft guidelines for implementation of the new law.
Again, in principle, this type of transparency is a good thing. But when the new law results in a list of consulting fees and other payments made by pharmaceutical and medical device companies to physicians, there will be a piece of the puzzle still missing. What is the purpose of that exchange beyond a minimalist bureaucratic definition such as "consulting fee?" What was the impact for patients and for the current and future practice of healthcare? Without this context, negative inferences can be made about any exchange of value.
The fact is that collaborations between physicians and industry have led to some of the most important medical breakthroughs of the last several decades. Physicians help guide industry on how to make new innovations beneficial for patients. Companies train physicians on the optimal use of new drugs and devices. This sharing of knowledge is essential to the advancement of healthcare.
We'll be discussing this issue in greater detail in the months ahead. HLC launched an initiative called the National Dialogue for Healthcare Innovation and, through this effort, multiple organization representing healthcare providers, health industry sectors, academia and patients have been developing a consensus set of principles to help guide future physician-industry collaborations. More to come.