Should Wal-Mart Make Smokers Pay More for Health Insurance?

A recent article about changes Wal-Mart is making in its health insurance program reports that smokers will be required to pay an extra $10 to $90 each pay period — $260 to $2,340 a year.

Is that fair?

Greg Rossiter, speaking for Wal-Mart, defends the policy on the basis of cost - “Tobacco users generally consume about 25 percent more health care services than nontobacco users.” But patients with cancer also "consume" more health care services. I doubt that Wal-Mart intends to raise their premiums.

Wal-Mart doesn't justify the tobacco penalty by cost alone, but rather by cost combined with the conviction that smoking represents a choice.

Smoking is obviously harmful, and smoking cessation will be good for the individuals who stop, the cost of the corporate health program, and the impact of secondary smoke on others. But Wal-Mart's program is wrong.

Nicotine is addictive. Addictions don't stop on a dime. Here's what I would have recommended to Wal-Mart:

1. "If you haven't done it already, involve a council of "associates" (the Wal-Mart term for employees) in developing the policy re smoking."


2. "Give associates advance notice of the financial penalties - no less than a year, perhaps two."


3. "Offer strong support for smoking cessation."


4. "Make sure the financial penalties aren't 'too large.' The aim of the penalty should be to focus attention on tobacco use and send an educational message, not to cover the incremental cost of health care. $2,390 is way too much for anyone but a senior executive."

A country with a tax-supported health system that covered all citizens would locate incentives where they belong - at the point of purchase, not as part of the health insurance premium. Tobacco, beverages with high sugar content, and other products that harm individual health, public health, and add to the deficit, would be taxed at a high enough level to create a disincentive and to account for the costs the products create for the public.

I'm entitled to smoke if I wish, but I'm not entitled to make you pay for the future costs my smoking entails.

Given our reliance on employer-based health insurance for 60% of the population, it's ideal for employers to take a public health orientation towards employees. I think Wal-Mart is right to take on smoking as a public health issue for its employees, but clinical and ethical considerations require it to modify the way it's approaching the issue.

The Good Samaritan didn't ask the wounded traveller if he'd brought on his condition by faulty choices!