> We are already flirting with corporate-employment-as-citizenship

We're done with flirting, we're already probably at second base as if you take a cold hard look at the corporate-employee relationship in America, we've basically reinvented a new form of feudalism.

We already have drug testing in many industries, particularly shipping.

https://www.portseattle.org/sites/default/files/2018-03/Drug...

What everyone's missing here is that drug tests are basically a joke for everything except THC (of which the metabolites are fat-soluble and take longer to excrete).

You can just not consume nicotine for a couple weeks and then go take your test. If you're using harder drugs like meth or heroin, you don't need to wait nearly as long. Using someone else's urine is also easy, but this is a crime in many states.

Is UHaul really going to hair + blood + urine test each employee not only before hiring, but randomly throughout employment? That gets expensive fast.

Ultimately the whole thing is silly. Show up, do your work well, and leave. Simple as that. (Yes, dangerous jobs like pilots and ambulance drivers should probably be randomly tested during work hours to ensure common-sense responsibility.)

This is sort of missing the point.

If my employer wants to make my employment contingent on not entertaining subversive thoughts, they'll have a heck of a time doing it today. Maybe they can e.g. devise some questionnaire or half-assed Voight-Kampff-style test that appeals to upper-middle-manager types with its high price tag and euphemistic-authoritarian marketing verbiage, but one has to imagine it would be fairly easy to fool.

So from a certain perspective, it's not really worth worrying about. But then, when they figure out how to really make it work, we're already living in a society where the theoretical concept of it is completely mainstream and acceptable, and at that point what will stop it from becoming the new status quo?

Most nicotine users can't just "not consume nicotine for a couple of weeks" without physical side effects. Most of the ones who can, already have given it up.

The overuse of employee drug testing should be forbid too, unless there are specific good reasons for it.

In fact I think it's pretty revealing as to how poorly our society treats and thinks about people suffering from addictions that this discussion is only being had now that it hits people niccotine addiction, which is far less stigmanized than most other harmful drugs. Arguably, before, people didn't care, because it only hit the less-than-human "junkies".

To see if you're illegally operating port machinery in a state likely to kill people is a different discussion than "did they have a smoke on their day off?"

Do they test for Ambien use?

> If we start allowing corporations to dictate what their employees do in their own time, where does it stop?

Especially with something that doesn't impair your cognition or ability to do your job, even when taken a brief moment before you start working.

If we’re going to saddle employers with paying for health insurance, it would seem odd to restrict them from trying to have healthier employees.

(Hint: I’m agreeing with you.)

> If we start allowing corporations to dictate what their employees do in their own time, where does it stop?

It stops or ends with the persecution of people who helped with the persecution of previous groups - because you don't need that kind of people in your company anymore.

You can deny employment if a prospective candidate is fat or for numerous other superficial reasons. I don’t see much of a fundamental difference.

Found the smoker.

Joking aside, non-smokers should not have to pay the insurance costs of smokers. It is all fine and good if you want to do that to yourself, but you should also have to pay for it. Simply not hiring smokers is the right decision, they dont get tangled up in the details of sorting out what diseases stem from smoking and what are natural.

It's different paying for insurance to cover incidents or conditions that people can't control (accidents, genetic diseases), or would be bad for society to not cover (pregnancy, psychological issues).

> non-smokers should not have to pay the insurance costs of smokers

The very idea of insurance becomes toxic when you start to pursue this idea. Everyone has some non-virtuous behavior we can identify in order to exclude them. Maybe your colon cancer is because you didn't eat enough fiber, so we're going to cut you off too.

All of this is why it makes no sense to have multiple "pools" for health insurance, because then it creates incentives for people like private insurance companies or employers to cherry-pick the healthiest people for their pool.

What costs more for health insurers?

A cigarette smoker that dies between 40-70 with what treatments for diabetes, bloodpressure, asthma, copd, and a heart attack before cigarettes kill them young?

A non smoker that lives to 105 but needs two hip replacements, cancer treatments, and assisted living between 60-80, then round the clock care for the next 25 years?

Obesity is far more widespread than smoking and costs everyone far more money. Should we cut off fat people from healthcare too?

> The very idea of insurance becomes toxic when you start to pursue this idea

Not really. In general an insurance protects you against risks outside of your control and/or they penalise you for increased risk, and will refuse to pay for intentional losses. We all experience this with car and home insurances.

Smoking and its health consequences are a personal decision and there is an argument that you should not expect others to subsidise your life choices.

That being said, in many countries smokers are indeed made to pay because tobacco products are heavily taxed and proceeds are used to fund healthcare.

In fact, I believe that for example in the UK taxes on tobacco products bring in more money than smoking costs the health service.

As someone who took up smoking when I was young, stupid, and vulnerable, describing it as a personal decision doesn’t fit my reality. I quit eventually but it took 15 years of stop-start, combined with a constant, desperate sense of guilt and failure.

There are limits to free will. Depressed, anxious, abused and sick people are statistically more likely to make poor life choices. Let’s give them a break.

Agree with what you say though. I live in the uk and it did ease the guilt a little knowing that I was at least paying my way.

Tobacco companies, and really every major branded company product, rely on manipulating shoppers vulnerabilities to make money. Advertising has caused a lot of problems that we cannot address until we excise the source.

I'm fully supportive of banning all substance use from tv that is not made by a nonprofit for educational purposes, forcing all substances to use generic black and white labels that Are only differentiated by the brand name written in size 12 font on the back of the container with the warning labels in size 16+ font on the front. Likewise banning all advertisements, and the sale/distribution of branded products associated with companies that sell drugs.

Some vulnerable people will always make bad decisions, be it smoking, alcohol, drugs, or what not.

But the point remains that smoking is overwhelmingly a personal decision.

It's commonly stated(Idk how true it is) that smokers cost the NHS less thank non-smokers because they die much more quickly.

The problem with this thinking is where do you stop? I don't want to pay insurance costs for motorcycle riders, overweight people, people who play contact sports for fun, etc.

Agreed, slippery slope indeed.

Or maybe we should just disentangle health care from employment..

And once we're all on mandatory government healthcare, how does that reduce the incentive for the government to dictate the exact same policies (vis a vis 'penalizing the smokers, the overweight, the gun-owners, the non-conforming') under the guise of "Well it's cheaper if we do it..."

Bonus, there's even MORE motive (of the 'means, motive, opportunity' triangle) for them to continue turning the surveillance state against ordinary folks to find out "who's actually smoking and lying about it to their doctor?"

ACLU called it back in 2006 - https://www.youtube.com/watch?v=JMCjnZyU1Lg

Smokers and the overweight vote.

Using my country as an example, any attempt to meddle with the universal healthcare system is treated with immediate and intense hostility by the voting public. The government floated the idea of introducing a $5 copay several years ago and it was met with almost unanimous contempt. The idea was promptly canned.

If voting changed anything, we wouldn't be allowed to do it.

Best answer

One could argue that type 2 diabetes is something many inflict on themselves. Should people without this disease pay for their treatment?

What if the person with type 2 diabetes is a 15 year old kid, and their parents taught them bad eating habits which lead to type 2 diabetes? Should the parent's insurance cover that? Or should the parent not get hired because of something their dependent did to themselves?

No, but we should have a tax on sugar that offsets the cost of sugar-related illnesses like diabetes and obesity. Let people make their own decisions, but don't socialize the costs of substances we know are harmful like sugar and drugs.

This solution has many virtues. It discourages harmful behavior without being paternalistic. It comprehensively prevents an entire class of free-rider problems. It prevents people feeling like they're subsidizing another's bad behavior because everybody knows the smoker is paying their way.

And decades ago, people who ate "too much" saturated fat would have been penalized while people who replaced it with hydrogenated oils would have paid less while ultimately costing much more. All these years later, we now know that there was some pretty bad dietary advice/policy and the result could have been a whole lot worse if people were financially incentivized to change their diets.

This is a reasonable counterargument—though I'm not especially persuaded and it's a little bit of a straw man. Are you arguing that there's not enough evidence to substantiate an actionable belief that nicotine, alcohol & sugar correlate with significantly increased health costs? We already tax two of these on that premise—though not nearly the levels required to offset the costs they create.

Healthcare should not be tied to employment (see: corporate-employment-as-citizenship), and the general health of the population is (tautologically) a public health concern that needs to be addressed from the top, not the bottom.

Trying to "fix" people's addictive behaviors by denying them employment is like trying to cure the common cold by wrapping the patient's head in duct tape so they can't sniffle and cough anymore. Poverty and stress are uncontroversially regarded as risk factors for addiction, and in America if you don't have a job and you aren't a multi-millionaire then poverty and stress are what you will get.

Oh, and no, I'm not a smoker. I do drink a lot, which is something that's arguably just as bad or worse than smoking and yet nobody seems to give a fuck about it. Why is that?

Alcohol is back en vogue thanks to craft breweries making night and weekend alcoholism a fun hobby.

The alcohol industry is also trying to modernize itself to compete against looming cannabis legalisation.

Extrapolate that to diabetes, obesity, sports injuries, not exercising >3 times a week... and you start to see why that sort of orwellian control is problematic.

Please note that Uhaul is not banning smoking/smokers, they're banning nicotine, which is a stimulant similar to caffeine. The difference is that historically the most prevalent delivery mechanism for nicotine has been to smoke it, and therein lies the health concern. Some might say this is merely a theoretical difference, since portable vape cartridges also contain potentially harmful additives, but this is more of an economic problem - like cigarettes, it's cheaper to include, or fail to exclude, additives that are harmful to humans when vaporized and ingested. However, there's no technical reason a product couldn't come to market tomorrow that would offer a nicotine delivery mechanism free of side effects. But we'll never find out because for years nicotine has been lumped together with smoking as a terrible harmful thing, and that's simply not true.

That product exists. Tobacco free snus pouches.

statistically, smokers die early enough that their lifetime healthcare costs are lower than that of nonsmokers. I guess that doesn't really matter to a company that only pays for current employees' coverage, but it's an interesting fact.

I don't currently, but I smoked for about eight years. afaik, this significantly increases my chances of various respiratory problems. I don't mind having that accounted for in my premiums as long as you're willing to open up about your lifestyle and see how we can adjust your premiums. :)

> non-smokers should not have to pay the insurance costs of smokers.

I don't want to pay for the insurance costs of alcoholics, diabetics and obese and sedentary people. Where do we draw the line? One of the problems with the US insurance mindset is this type of blame. Is it self-inflicted or not? Who gives a shit, honestly. It's a disease, that's why insurance exists.

I think it gets hard to draw the line. Should we have to subsidize obese coworkers? Or ones who partake in extreme sports?

While we're at it, what about elderly people costing 100k+/yr in medical care?

I’m a non-smoking nicotine user. Should I also be included in the blanket ban by uhaul?

> Should my employer have the right to impose a curfew on me so that I'm not tired the next day at work?

I bet the military has done that for centuries. Though I wouldn't want companies too start drafting people.