Should smokers and obese workers pay more for health care?

In an effort to curb rising employer health care costs, some companies are making employees who smoke pay higher rates. — (Image credit: Dave & Les Jacobs/cultura/Corbis)

For years, employers have been trying to rein in sharply rising health insurance costs by encouraging workers to become healthier, usually by giving up cigarettes, or exercising to lose weight and lower blood pressure and cholesterol. That "carrot" approach hasn't exactly been an overwhelming success. Now, according to an October survey for the National Business Group on Health, more employers are turning to the "stick": Next year, 40 percent of large and mid-sized companies plan to raise health coverage costs for workers who smoke or won't voluntarily get in shape, up from 8 percent in 2009. "Nothing else has worked to control health trends," says the business group's LuAnn Heinen. Is penalizing smokers and obese workers a fair solution?

Welcome to the "Nosy Employer Society": Forget the Nanny State, says Paul Wallis at Digital Journal. We're all in even bigger trouble if private firms think they have a "God-given right" to butt into what their employees do outside of work, then dock their pay for it. Smokers and the obese surely aren't alone on the "hit list of the Cost Messiahs." What's next — higher health insurance costs for employees with asthma? Allergies? STDs? Somebody needs to sue "these crooks in health insurance and the ultra-stingy employers" for medical discrimination, so at least "they don't benefit from this scam."

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But employers have to do something: "Everyone is feeling the crunch" from soaring health costs, says Heather Asiyanbi at Patch. And asking "employees to shoulder more of the responsibility" isn't just fair — it's also an effective tool to improve worker well-being. One federal study, for example, found that obese people spend an extra $1,429 on health care each year, and those costs are borne by all of us. Of course, smoking and obesity aren't the only things driving up health costs, but every bit helps.

Let's get employers out of the health care business: Spiking health costs obviously create "a terrible situation for American companies and American workers," says David Lazarus in the Los Angeles Times. The fix: Get employers "out of the health care business." No other developed country delivers health coverage through employers, and the U.S. does so only through "a historical accident" leftover from World War II, when businesses began offering health benefits "to attract workers during a government-imposed wage freeze." If we can't have "Medicare for all," then workers should buy their own portable coverage through regulated insurance "exchanges."