Drawing a line in the sand: Questioning punitive tactics against employees who smoke

Lately, it seems as though a week doesn't go by without a survey inquiry from a neighboring city or county about how Palm Beach County is encouraging or mandating employees to quit smoking.

Surveys are a great tool for Florida's local government agencies to gain free comparative information because of very broad public records legislation known as the Sunshine Law. Under its provisions, there's little benefits-related work product that we aren't allowed - or, in fact, compelled - to share. Lately, it seems the hottest topic of comparative conversation, when it comes to wellness programs, is smoking cessation.

Some of our peers have stopped hiring smokers. Others have implemented a smoker surcharge for health care premiums. Others have even taken the bold step to medically test employees who make the promise to remain nicotine free to ensure there are no traces of it in their system. Others still, including yours truly, have implemented programs that waive copayments and other costs for smoking-cessation drugs and programs.


Proving incentive ROI is virtually impossible

So which approach is best, and which provides the greatest return on investment to a health plan - the so-called carrot approach or the so-called stick?

I'm becoming more convinced that it would be easier to prove the existence of life on other planets than prove the true return on investment of a wellness incentive. Our friends at the Society for Human Resource Management did a study a couple of years ago that determined the cost of one smoker on an employer's health plan could bloat the bottom line by about $1,600 per year. Depending on how many smokers are covered under a plan, that number could expand pretty fast.

This, coupled with the inevitable absenteeism that follows serious smoking-related illnesses, could certainly make the case that eliminating smoking from the workplace would be in the best interest of all concerned.

With that evasive ROI lurking somewhere in the realm of the unknown as we roll out the first few months of our smoking-cessation program, which is heavily concentrated on carrots, I watch my peers with interest. If they're able to show significant savings as a result of their firmer approaches to smoking cessation, I'll have no choice but to share those savings with the Board, and perhaps even recommend a similar approach.


Where to draw the line?

But then I think about some of the coworkers I've admired over the years. Before joining Palm Beach County, I had the privilege of serving as risk manager for a city in Florida with a population of about 100,000 people. The city manager was a graduate of West Point, served as a decorated Army captain and became one of the longest-serving and effective managers in that city's history.

His years of disciplined fiscal stewardship continue to serve the city well as other neighboring cities face critical budget shortages that threaten services. But he was a smoker.

So it begs the question: What kind of talent do we forfeit when we fail to retain, or refuse to hire altogether, because we've chosen one personal vice and made it an employment matter?

Where do we draw the line? Smoking is associated with a number of very costly and nasty illnesses. Lung cancer is just the tip of the iceberg. Smoking has also been linked to many other forms of cancer, emphysema, heart disease and a number of other illnesses - each one a costly hit to a health plan.

But similar illnesses can occur in people who are obese, consume too much alcohol and/or don't keep their cholesterol and blood pressure within a healthy range. And employees who drive too fast or fail to use their seatbelts also can affect the bottom line of a health plan.

Where does the ultimate responsibility for an employee's well-being lie? Is it with the employer? Is it with the employee? Is it a combination of both?

Perhaps in an age when the cost of health care has become so overwhelming for American employers, we feel that a line in the sand is necessary.

Most of us would agree that personal responsibility plays the most important role here, but we share the burden with our employees. As they are responsible to themselves and their families, we are responsible to our shareholders (or in my world, taxpayers).


Carrot in a land of sticks

I remain confident that my carrot approach is worth a try in what seems to be a land of sticks. If we make kicking the habit a condition of employment, we could be missing out on some very talented and experienced individuals. For example, half of the country approves of President Obama, who was a smoker when he was elected.

For plan year 2011, Palm Beach County employees who smoke will be encouraged to take advantage of smoking-cessation programs and drugs at no cost to them. Maybe they'll finally kick the habit and in lieu of a cigarette, they'll opt for a carrot stick.

Contributing Editor Nancy L. Bolton is the director of risk management for the Palm Beach County Board of County Commissioners in West Palm Beach, Fla.

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