"You Smoke? You're Fired"

USA Today summarizes how some companies are firing or refusing to hire workers who smoke while away from work. Meanwhile, the San Francisco Chronicle reports on a study that shows that companies who provide health insurance on average pay smokers less than non-smokers, but no such differential is seen at companies that don't provide such insurance.
Obviously, smoking is an unhealthy habit that increases risk of a number of serious disease. As a physician, I am always encouraging patients not to smoke, or to quit cigarettes. But many patients find it very hard to quit, mainly because the nicotine in cigarettes is highly addicted.
Although I continue to urge such patients to quit, and try to find ways to help them do so, I personally don't think that they deserve to be blamed or shamed.
However, the two stories above seem to illustrate, as I've said before, how companies that pay for their employees' health insurance (presumably with money that would otherwise go the employees as salary) seem to see this transfer of funds a license to control their employees' private behavior. This heavy-handed approach seems like more of an abuse of power to me than a valid approach to public health. As a physician, it's hard enough to try to get patients to quit smoking. For such a patient, losing their job because of the habit adds more than insult to injury.

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