Ochsner CEO Rails Against Smoking

Ochsner Health System CEO Patrick J. Quinlan, MD, understands the unease that many people feel with the potentially invasive nature of workplace wellness programs.

How far may employers intrude into the lives of workers in the name of lower healthcare costs and higher productivity?

For Quinlan, however, the clear point of demarcation is smoking.

On April 1, the New Orleans-based, eight-hospital health system and its more than 13,000 employees marked their one-year anniversary as a tobacco-free workplace. HealthLeaders Media spoke with Quinlan this month to mark the anniversary and record his broadside against tobacco—one of the biggest sources of preventable death in the United States.   

"I am sympathetic to the idea of 'where do you draw the line?'—which is both true and a debating tactic that attorneys and anybody else can use to reduce something to the absurd," Quinlan says.

"This has nothing to do with eating Hostess Twinkies. This has nothing to do with anything other than a poison that shouldn't be here today," he says. "This is a scourge that has somehow become normal and the costs are enormous. In Louisiana alone it's $3 billion in lost productivity and 6,500 people dying directly. This is all tangible. You can't say that if someone gained a pound or didn't walk around the block."

Quinlan contends that smoking occupies "a wildly different category" where the individual's right to smoke should not outweigh the health menace and financial burden tobacco imposes on others in the form of higher health insurance premiums, medical costs, and lost productivity.  

"We are getting into your life because what you do in your life is directly paid for by me," he says. "If you go home and watch television I don't pay for that. You don't send me the bill for your cable. No, that's your business. The demarcation between rights and responsibilities and who carries the costs is a fairness issue."

"This has been flipped to where somehow my right to choose what I want to do has been translated to my right to make everybody else bear the cost of my choices," he says.  

As for efforts to eradicate smoking among Ochsner employees, Quinlan says the self-insured health system's approach includes premium discounts for employees who don't smoke and cessation support for employees who do.

"Repeated studies show that people want to quit smoking, but it is an addictive behavior and usually the more you push on people in a way that generates resistance, you don't help them. There has to be acceptance for there to be change," he says. "And the tack that we take is that this is an unfortunate and addictive habit that people develop early in life often with the acquiescence of government and society."

Quinlan is particularly incensed by laws in Louisiana and more than two dozen other states—pushed by Tobacco industry lobbyists—that prohibit employers from discriminatory hiring policies against smokers.

"We have a tobacco cessation person we are hiring to run our program but we could not stipulate that the person who leads this had to be a nonsmoker. That is kind of bizarre," he says.

The physician-executive says laws protecting smokers work at cross purposes with societal efforts to reduce healthcare costs. Studies show that smokers can cost employers as much as $3,400 a year in increased healthcare costs and lost productivity. "Often at the local, state, and federal level there is this intense scrutiny on the cost of healthcare. Yet we are particularly silent on the leading cost of avoidable death and disease in this country," he says.

"Our position is, if government can't help in this regard, at least get out of the way of employers and employees trying to decide how they best can preserve benefits for everybody."

"The broader issue is we see what is happening with healthcare costs. We really need to avoid those diseases that we have control over so we can save the benefit and costs for those who have diseases for which they have no control."

As resolute as he is against smoking and its destructive costs, Quinlan is also puzzled by the view of some that the battle for a smokeless society has already been won. "Smoking is embedded in this country and we need to recognize that it is a battle thought to have been won but it is far from over," he says.

"I hear people say 'well it's really not a problem anymore is it?' When over one-in-five people smokes and the death tolls and the destruction and the cost is enormous, we have become so accustomed to it that something like one out of five is deemed OK. What is so odd about this is that the poisonous nature of smoking and the addictive nature are so clear, the cost is so high, yet we are relatively indifferent to the magnitude of that threat."

Quinlan suspects that any premature victory celebration in the war on tobacco comes from the generally better educated and wealthier people who don't smoke. "The people I often associate with say there is no smoking," he says.

"None of my friends smoke, but in fact studies clearly show that the poorer you are the more you smoke. The blacker you are the more you smoke. The more mental illness you have the more you really smoke. So it's that invisible underclass that smokes. It is the underclass that has the worse outcomes. That is more than a coincidence. It's cause and effect."

Quinlan says that at some workplaces, the one-in-five people who still smoke should not be surprised if coworkers pressure them to quit or move on. "People won't mind intervening with you and saying 'Hey listen. It's not fair. We are struggling to maintain our benefits and you are literally burning them up. So if you want to do that fine. Just don't work with us anymore please. I don't want to pay your bill,'" he says.