Help Wanted. No Smokers Need Apply: A New Marketplace Podcast

(Photo: Julie Bocchino)

Our latest podcast is called “Help Wanted. No Smokers Need Apply.”  (You can download/subscribe at iTunes, get the RSS feed, listen via the media player above, or read the transcript.)

In many states (21, to be precise), it is perfectly legal for an employer to not hire someone who smokes. This might seem understandable, given that health insurance is often coupled to employment, and since healthcare risks and costs are increasingly pooled. And so: if employers can exclude smokers, should they also be able to weed out junk-food lovers or motorcyclists — or perhaps anyone who wants to have a baby?

That question is the thrust of this podcast, which features a conversation with Zeke Emanuel. He is a Penn medical professor/bioethicist; a former White House healthcare adviser; the author of Healthcare, Guaranteed (and Brothers Emanuel, about growing up with Rahm and Ari); and a coauthor, with Harald Schmidt and Kristin Voigt, of a recent New England Journal of Medical article (previewed on our blog) called “The Ethics of Not Hiring Smokers”:

EMANUEL: I’m a cancer doctor. I find smoking disgusting. I find smoking horrible. I wish that everyone who did it could quit. But I also recognize that it’s not voluntary, that most people start before they’re adults and that it’s incredibly hard to quit once you’ve started.”

Emanuel also appeared in an earlier Freakonomics podcast, “Is the Obesity Epidemic for Real?” In this podcast, he argues that not hiring smokers lies somewhere between discriminatory and unethical. Give us a listen and let us know your thoughts.

Audio Transcript

Kai RYSSDAL: Time now for a little Freakonomics Radio.  It’s that moment every couple of weeks we talk to Stephen Dubner, the co-author of the books and blog of the same name.  It is “the hidden side of everything.”  Dubner, long time, no talk, man!


Stephen J. DUBNER: Great to be back, Kai.  Thanks for having me.  I know you trained as a Navy pilot -- I wonder if you ever thought about afterward working as a commercial pilot?  Was that ever a plan?


RYSSDAL: No, not really.  That was never my thing.


DUBNER: Well, if you had, and if you had interviewed with, let’s say, Alaska Airlines, there’s something you would have needed to know. Here’s airline spokesperson Marianne Lindsey:


Marianne LINDSEY:  “In general, there’s a question that’s asked, ‘have you smoked or used tobacco products within the last six months?’  And we go by how the employee responds to that question.  And then, before they’re hired, they have a drug test that they take that detects nicotine use.


RYSSDAL: So Alaska Airlines would not hire me, were I a smoker.  Yes?


DUBNER: Alaska Airlines would not hire you if you were a smoker.  Now, they’ve had this policy for quite a few years.  And more and more companies now are refusing to hire anyone who uses tobacco -- a lot of healthcare firms, especially, and hospitals.


RYSSDAL: This has to be about cutting healthcare costs, right?


DUBNER: That’s a primary reason, for sure. Smokers are more expensive than non-smokers, if you’re the company.  By one estimate, about $4,000 a year more in terms of healthcare and lost productivity and so on. But there’s also the idea that you want to make every workplace healthier, which means smoke-free seems to be a good idea there.


RYSSDAL: Right, OK.  That makes sense.  Question number two, though, Dubner, is this: Last time I checked, smoking is legal, man.


DUBNER: Yes it is.  So, as it turns out, in terms of the legality of hiring smokers: 29 states have passed laws that don’t let companies turn down smokers, but the other 21 states do allow you to do that.  So if I’m a company in New York or North Carolina or California, I cannot reject an employee because he or she smokes. But if I run a company in Pennsylvania or Florida or Alaska, I can. So that’s a pretty severe split – which recently led to a piece in the New England Journal of Medicine about the ethics of not hiring smokers. Here’s one of the authors, Zeke Emanuel, who is a bioethicist and a professor at the University of Pennsylvania.


Ezekiel EMANUEL: “I’m a cancer doctor. I find smoking disgusting. I find smoking horrible. I wish that everyone who did it could quit.”


DUBNER: All right.  So it’s not hard to think that he’s in favor of not hiring smokers. Right?  But wait, there’s more:


EMANUEL: “But I also recognize that it’s not voluntary, that most people start before they’re adults and that it’s incredibly hard to quit once you’ve started.


RYSSDAL: OK, wait.  “Not voluntary?”  I mean, Zeke Emanuel is a smart guy and all, but huh?


DUBNER: That is really the basis of his argument – which is that most smokers want to quit, but can’t, and to refuse to hire them is therefore discriminatory or at least unethical.


RYSSDAL: Does this break down on socioeconomic lines?  Is there a low-income, low-wage worker versus high-wage, high-income person thing?


DUBNER: Yeah, that’s a great question.  So low-income people are substantially more likely to smoke than high-income people across the board. So, if you’re a low-income smoker and now can’t get a job because you smoke, it’s sort of a double jeopardy. But there’s also the fact that smoking is one of those activities – legal, as you noted, but publicly frowned upon – that seems to open a bigger can of worms in terms of hiring. Here’s Emanuel again:


EMANUEL: “Once you’re on this kick, you can say, ‘Look at those Seventh Day Adventists!  They’re the people we really want to employ because those guys -- they don’t smoke, they don’t drink, they eat very healthy, they don’t engage in high-risk sporting activities.’ That just seems to me exactly where we don’t want to be going


DUBNER: So Kai, you can imagine a future where nobody wants to hire anybody who does anything at all risky.  Maybe not even risky, but just expensive -- like becoming pregnant and having kids. Because, as we all increasingly share healthcare costs, that means that you increasingly are thinking about what I do because it affects what you’ll pay in insurance and taxes. In the case of smoking, it’s really all about the incentives.  In a tough labor market like ours, will it turn out to be that getting a job is a such a strong incentive that it might help a smoker who has tried everything, but everything else else has failed? I have no idea if that will work, but it will sure be worth keeping an eye on.


RYSSDAL: Stephen Dubner. is the web site.  Stephen, we’ll see you in a couple of weeks.

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  1. Pshrnk says:

    A point missed by many of these “don’t you dare be judgmental” type posts is that social disapproval is a powerful deterrent to behavior. Not hiring smokers increases the cost of a behavior. Increasing the cost of smoking decreases the number of young people who will try this horribly addictive substance. We owe it to our grandchildren, great grandchildren etcetera to increase the cost of smoking to save many of them from this addiction. It is moral to increase the cost of smoking for the benefit of future generations.

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    • chris says:

      They’ve tried that with sex, alcohol and other drugs and soon it’s to be done with food. It doesn’t work. Funny thing about people–they don’t like to be told what to do, especially in putatively free societies. Too bad they haven’t invented a time machine yet: you could go back to 17th century Massachusetts with the rest of the Puritans.

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  2. gkb says:

    I often see smokers (almost always in a group) gathered outside the office for a smoke. Assuming 4 smoke breaks a day at 15 minutes each (get up, go outside, light up, chat, come back, start again) I would estimate that each loses almost an hour a day to the habit. Unless they consistently work longer than non-smokers I would prefer to employ those people who don’t require more frequent breaks for productivity reasons, let alone worrying about insurance costs.

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    • Bri says:

      That’s a management problem not a smoking problem. If you can’t manage your employees maybe you’re the one that shouldn’t have a job. Many companies now have a no tobacco policy on their property, solves the problem pretty quickly.

      You’re also the perfect example of why certain forms of discrimination are illegal. By your own admission you’re prejudice against people who smoke because you assume that they all waste time taking smoking breaks. In reality though, your casual observations are a poor indicator of behaviors of the tobacco using population as a whole.

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      • Pshrnk says:

        Would you please cite a study to back your last sentence.

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      • Bri says:

        If you make a claim the burden of proof is upon the person making the claim, not on me! Also it’s called the scientific method, casual observations do not equate to a scientific study. You can’t observe 20 people and then proclaim that all traits of that subtype apply to all subtypes.

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    • chris says:

      Anyplace I’ve worked where smokers get smoke breaks, everyone gets similar short breaks to do whatever floats their particular boat. Smokers don’t get special treatment (at least not special positive treatment) or certain nonsmokers would scream bloody murder. Right?

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  3. corky says:

    I think it is more than just the health care costs that employers are looking at. As one other commenter noted, smokers take multiple smoking breaks during the day, which now usually requires that they go outside (the hospital where I work requires that they go outside and off of the property) which means at least a 15-20 minute break several times a day. And then they come back into the building reeking of smoke and sharing the secondhand fumes with their co-workers ( and yes I would complain about people who douse themselves in perfume the same way). in addition, in my observation of smokers around our building, they tend to toss the butts where they are smoking or on the way back into the building, leading to clean-up costs for the business owners (what business wants the walkway into their business littered with cigarette butts?). So there are costs, in time, clean-up, and co-worker comfort that need to be taken into account. And as for the airline, what airline wants its pilots or flight attendants jonesing for a cigarette while they are flying the plane or attending to customers?

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  4. Jerry S says:

    I’m struck by the fact that in the podcast, there is an objection on the grounds that it’s not the fault of smokers. Why is fault the criteria? A lot of companies don’t hire people without college diplomas and yet it’s not always their fault they couldn’t go to college. Should the NBA hire a talented player who is 5’5″ tall? It’s not his fault.

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    • Byung Kyu Park says:

      Because those things are job-specific—and specifically applies to the job performance—while the no-smoking criterion isn’t really job-specific or apply to job performance in most cases (healthcare, childcare, etc. excluded, of course), at least not in a direct, causal way, not just mere statistical correlation.

      Employers looking for truck drivers can insist that their employees be licensed to drive a truck—regardless of “fault” criterion. But it would silly for these employers to have “those under 6′ need not apply” criterion—or to make it a little more relevant to the topic, how would you feel if employers routinely checked a potential employees’ medical records (for chronic back problems, etc.) and discriminated against those with chronic health issues, even if minor—that’s where “fault” criterion makes a little sense; if it’s something that a person does to himself of his own free will, well, it’s his own damn fault, but if it’s something that happens to a person (like bad sight, bad back, etc.) there is some basis for sympathy and reasonable accommodation.

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  5. chris says:

    Couldn’t they have found someone better to speak for smokers than Zeke Emanuel? There are plenty of smokers’ rights advocates (and advocates for privacy and individual freedom in general) out there without having to resort to someone who finds smoking disgusting and smokers to be mindless zombies who have no agency or free will.

    I started smoking because it was “cool” and for years I kept it up as a vice I didn’t love as much as others. Now that there’s this dimestore jihad against it, I’ve never enjoyed it more. This was my first time listening. I was disappointed to discover how crushingly mainstream it was.

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  6. jaspreet says:

    My favorite compliment so far after one of Lonnie’s cuts

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    herbal vaporizers, Orange Krush,buds lega

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  7. Julien Couvreur says:

    This is a beautiful (but sad) illustration of Mises observation that intervention begets more intervention.
    Here’s a simplified story:
    1) you start by inflating money during WWII, and apply wage control to fix some of its effects,
    2) employers start using non-wage benefits to get around wage control,
    3) such benefits (medical benefits in particular) get ta advantages as part of other wellfare interventions,
    4) the healthcare industry starts shifting to insurance and especially group insurance tied to employment,
    5) prices go up (increasing the need for insurance) and most healthy people opt-out (selection effects which raise prices more) so you decide to force people to participate in insurance model,
    6) in addition to raising premiums for all, insurances try to find ways around the bundling of individuals of varying risks into same insurance groups,
    7) so you decide to forbid some forms of rational discrimination (and also considering pre-existing conditions for people switching jobs and therefore insurance providers),
    8) because premiums go up on employers they also try to apply rational discrimination (don’t hire smokers or pay them less),
    9) and so on.

    This is where initial interventions lead us. At the root, the tax benefits for employer-provided healthcare and other wellfare interventions shift the model to group coverage instead of individual healthcare and healthcare insurance. With regular insurance, people in similar risk groups pay similar premiums, in particular for risks which the individual can control (smoking, riding motorcycles, …).
    Some individuals pay higher premium (but can still have jobs) which incidentally gives them incremental incentives to stop risky behaviors. But loosing access to a job is not incremental, as it is much larger than the extra premium to pay for this behavior (4000$ according to the podcast).
    But instead, such individuals now either have a harder time getting a job or they shift their healthcare cost onto their healthier peers.
    Another likely outcome is so-called death panels (committees deciding to refuse treatment based on some rationing criteria), again because we don’t let riskier individuals pay more and we force those costs onto their healthier peers.
    This is a broken system all around which emerged largely from a number of unintended political consequences.

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  8. Blake Freeman says:

    I feel that this is right and wrong. it is right in my opinion because of the health risks and the rising costs of healthcare. but what isnt right is that if they dont hire a worker because they want to have a baby or they drive a certain type of vehicle.

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