President Bush Signs Genetic Nondiscrimination Act 527
artemis67 writes "This past week, President Bush signed the Genetic Information Nondiscrimination Act (GINA), which would prevent health insurers and employers from discriminating against individuals on the basis of their genetic information. GINA is the first and only federal legislation that will provide protections against discrimination based on an individual's genetic information in health insurance coverage and employment settings.'"
Does it ban access? (Score:5, Insightful)
( and no i didn't read it, it would be to large to wade thru on a holiday weekend )
The Devil's In The Details (Score:5, Insightful)
I tend to look on such legislation as likely to have the reverse effect to the one stated, because it is frequently written to provide cover, loopholes and exceptions for the powerful, well-connected industries it is supposed to govern.
And even with the best of intentions, it often has the effect of limiting an individual's rights to whatever is covered at the time, regardless of scientific and technological advances that can render such rights and protections woefully obsolete.
Re:The Devil's In The Details (Score:3, Insightful)
About Time (Score:5, Insightful)
As for loopholes, we the public must start an intolerable outcry the moment we hear of any such pending. This needs to be an across-the-board absolute, not a political game.
Re:First time Bush has posted something sane. (Score:1, Insightful)
This is fine and all... (Score:4, Insightful)
And for good reasons... (Score:5, Insightful)
But the reason none of them should have supported this is that the result can and will drive up the cost of health care for everyone.
If someone knows they are genetically disposed to malady "x", there is now a law which guarantees that they can get insurance coverage at the same price as someone who is at less risk. What does Congress expect them to do, not take advantage of that fact? If insurance companies can't set pricing based on full knowledge and actuarial statistics, but people can, it will increase costs.
Finally, why shouldn't people at greater risk pay more? Discrimination is not necessarily a bad thing. People discriminate all the time - employers discriminate by choosing more skilled workers over less skilled ones, consumers tend to discriminate against higher priced retailers, the President discriminates against the proles by shutting down traffic as his motocade makes it's way though a city. (Well, maybe that last one is bad discrimination).
In fact, this law discriminates against those who are at less risk for genetically identifiable diseases, by forcing them to pay higher insurance rates than they otherwise would.
Re:The Devil's In The Details (Score:3, Insightful)
If you apply for insurance and on the phone the rep tells you that you can't have insurance because they are not taking applications right now from your zip code area/state (or some other "good" reason) when he sees information on a screen about you not to be insuarable - are you having any leverage to sue because of DNA discrimination, not even to talk about financial resources?
The US health insurance system is totally hosed. It is based on profit maximazing of individual insurance companies and not broad risk distribution as in other countries. If an insurance company finds a means to increase profit, they will do so - fat chance that this will change anytime soon as long as the polititians sell their soul for money to get elected and stay in "power".
Re:And for good reasons... (Score:5, Insightful)
Re:And for good reasons... (Score:4, Insightful)
How does it change the status quo? Insurers have been working on the basis of averages without genetic information for a very long time. There are factors driving up the cost of healthcare, but a lack of access to genetic information doesn't seem to be a major one.
Re:And for good reasons... (Score:5, Insightful)
That's the most fucked up reasoning written on slashdot in a long time. How is someone able to take advantage of being more likely to carry a genetic disease? Why should someone born with a genetic disorder have pay premium for something that is absolutely out of their control?
Being able to aquire medical care when in need is a basic human right. If you don't like that fact, then there are plenty of third world countries you can ove to where the evil state won't "steal" your money to provide health care for the sick.
Re:And for good reasons... (Score:5, Insightful)
Re:You Liberals can thank yourselves for $4/gal. g (Score:3, Insightful)
Re:This is fine and all... (Score:3, Insightful)
Not that I support the state of the insurance industry, or even anything close to it, but if all the people with severe problems could be guaranteed acceptance for medical insurance it would bankrupt the entire industry. No more health insurance for anyone.
This is a statement coming from someone who would benefit an extraordinary amount from a lack of such limitations, and I still think it's an atrocious idea.
Personally, I'd like to see states require that insurers of any kind operate as NFPs.
Re:First time Bush has posted something sane. (Score:5, Insightful)
You can't compare this to genetic discrimination. People have no say in what genes they're born with, but they most certainly have a say in whether they choose to engage in behaviors that drive up healthcare costs.
Maybe the answer would be to charge higher insurance premiums for such behaviors, maybe it's something else. But it's definitely not on par with genetic discrimination.
No.. (Score:4, Insightful)
What has changed... (Score:3, Insightful)
let the discrimination begin (Score:3, Insightful)
there's still prejudice! (Score:3, Insightful)
Re:First time Bush has posted something sane. (Score:3, Insightful)
That said, prohibiting smoking on the job is perfectly OK.... just as requiring drinkers to show up sober is reasonable.
Re:You Liberals can thank yourselves for $4/gal. g (Score:4, Insightful)
Re:First time Bush has posted something sane. (Score:1, Insightful)
From 9am-5pm, follow company policy. What someone does from 5pm to 9am is their own damn business.
First this will start with smoking. Then they'll discriminate on how you eat, then if you exercise, etc.
For the record, I don't smoke and am mostly vegetarian (I eat eggs and fish occasionally).
Adverse selection (Score:5, Insightful)
The problem with this law is that it creates adverse selection in health insurance. Health insurers won't be able to get genetic info on the people they're covering, but the people themselves will. That creates asymmetric information, and is ripe for abuse. Think about it: if I get my DNA sequenced and find out that I'm a walking health hazard, then I'll buy the most comprehensive policy out there. If I find out I'm genetically clear, I scale down my coverage, or drop it completely. Meanwhile, the insurer can't adjust my premium to accurately reflect my risk. The result: only genetically unhealthy (and risk-averse) people will buy into health insurance pools, or the genetically health will only buy insurance for physical accidents. And when the insurance pools are small, and the insurers can't accurately price risk, they pools collapse: nobody gets health insurance.
Of course, the obvious alternative--let both buyers and sellers of health insurance use DNA analysis to accurately price risk--is unpalatable because people will suffer from higher premiums through no fault of their own (i.e. because they have bad genes), and people will benefit through no effort of their own (i.e. because they have good genes). This concern (coupled with privacy concerns) is why GINA passed overwhelmingly, and I don't mean to diminish it.
Insurance works best when the risks aren't ascertainable in an individual case but are ascertainable in the aggregate. DNA sequencing really threatens the concept of health insurance, because it greatly decreases the uncertainty surrounding an individual's health future. The best way to keep insurance alive is to insure before it is possible to determine a person's health risk. Now, you could do that by banning DNA testing for individuals unless they are willing to permanently waive their ability to buy or modify their health insurance policies, but DNA testing is so cheap that the ban will be hard to enforce, and a permanent waiver seems rather harsh. You could require people to buy insurance for their kids before conception, but that has the same problem that the kid will be stuck with the same health insurance for ever (and that there might not be a kid in sad circumstances)
The ultimate, fool-proof solution: social gene insurance. Essentially, when any private insurer wants to charge you more than the base rate because of your genes, you just pay the base rate and society picks up the difference. The gene insurance would be funded through taxes, much like social security is now, though none of that "lockbox" BS. Socialized health insurance would work, too, being a superset of social gene insurance. The idea behind social insurance schemes is that they in effect force citizens to buy in before anyone has any knowledge of their genetic risk, making it a sound insurance product. And the solution works from the view of liberal theories of justice, e.g. Rawls, because it is essentially a redistribution of social resources from those who happen to be born with (and hence do not deserve) such resources to those who happen to be dealt a bad hand, through no fault of their own.
Re:Jame Watson has 32 "dangerous" genes (Score:3, Insightful)
"All our social policies are based on the fact that their intelligence is the same as ours â" whereas all the testing says not really."
"There is no firm reason to anticipate that the intellectual capacities of peoples geographically separated in their evolution should prove to have evolved identically. Our wanting to reserve equal powers of reason as some universal heritage of humanity will not be enough to make it so."
Watson was forced into retirement for saying that wanting everyone to be "equal" doesn't make them so. Of course, the moment that the POSSIBILITY of any inherent inequality is brought up, any rational debate is impossible because no one wants to consider it.
It's the secular equivalent of heresy. The mob isn't interested in disproving what was said; they simply want to silence or destroy the person saying it.
Yes... (Score:1, Insightful)
The insurance industry has become more and more of a problem as more and more people have started misunderstanding its purpose. Insurance is for events that are hard to predict when they will happen or at what cost. An example of this misunderstanding is when people want insurance to pay for periodic checkups.
Don't get me wrong above: I'm not saying that the insurance industry has been perfect. I'm just saying that the real problem is the shift in expectations from insurance away from what it was designed for.
Why not just make this obsolete? (Score:5, Insightful)
Then we can say just mandate that everyone has to carry individual coverage so we solve the uninsured problem. Plus we would insure that the young and healthy were in the pool - thus keeping the overall rates down.
Of course it would be a lot easier to deduct it from people's paychecks rather than have a whole system whereby we monitor citizen's compliance with the law. So it would just be an amount deducted from your pay.
And we would need to make it something people who were poor could afford, so there would be subsidies so that the poor paid less... and the wealthy paid proportionately more. So it would be a progressive deduction from your taxes.
Plus we could save a LOT if in addition to providing preventative care instead of what we do (ER care as a last ditch effort when diseases are harder and more costly to treat) we got rid if the thousands of insurance providers and just had one large provider. I know as a physician I spend a lot of money on hiring people just to fill out insurance forms for me. If there was one form that was consistent, I would be able to provide care a lot more economically. And if everyone was in the same system, we would have better assurance that the care would be reasonable since the people with the most power would also have to have that same insurance... no way to make what the poor get be shoddy. So we would just cover everyone under one large pool.
And then.... well we'd have the most humane and cost effective system possible: a single payer national health service funded by an income tax spread fairly on the population. Or as the nutters refer to: socialized medicine.
Gasp!
Re:And for good reasons... (Score:4, Insightful)
Re:Adverse selection (Score:2, Insightful)
Jeebus. Insure the population as a whole. Reap the premiums. Pay reasonable and accepted prices. Charge users for average overall cost. Profit [as a society].
The USA is behind the rest of the industrialized world in life expectancy and overall health. Perhaps we should change our ways.
Re:First time Bush has posted something sane. (Score:4, Insightful)
I think this post, more than any other, called for: [citation needed].
Repeat after me, physician, (Score:5, Insightful)
Re:First time Bush has posted something sane. (Score:5, Insightful)
Re:And for good reasons... (Score:5, Insightful)
No. If you choose to drive a vehicle with more risk of being stolen, the insurance company charges you more to be insured. You've assumed a voluntary risk and the insurance company dings you.
When you sign up for life insurance, if you're a 63 year old smoker you won't get as favourable rates as if you were a healthy 18 year old.
The part that makes people uncomfortable about genetic discrimination is the eugenic angle. Nobody is able to control the genes that they are born with, and discriminating against groups of people based on factors beyond their control is usually a pretty crappy thing to do.
Genetics is not a "lifestyle choice" (Score:4, Insightful)
In fact, it is (rightly) common practice amongst medical and home insurance providers already to charge extra premiums to policy holders who smoke, and to deny coverage/claims to those who falsely declare themselves non-smokers in cases where smoking is at the root cause of the claim. That is the way it should be, and there should be no law preventing individuals or institutions from continuing the practice.
It is not inconsistent to support something like GINA and also support the freedom to discriminate in favour of non-smokers because the latter is a lifestyle choice, and the former, GINA, in my opinion is at its heart an update of laws against racial discrimination.
People aren't born with cigarettes in their mouths, and not only are we not forced to smoke, we have been told for decades that smoking is an unhealthy lifestyle choice that's best not even started. I cannot comprehend why anyone in this day and age would want to start up a smoking habit knowing what a totally stupid idea it is. Smokers deserve to pay more for (or be denied) insurance and pay a large "stupid tax" on tobacco. I think it is their right to be stupid and do stupid things, but I also believe that those who exercise their right to do stupid, destructive things should bear the full responsibility to cover the costs incurred.
Conversely, in this day and age, we know a lot about genetics to predict, to some degree of accuracy, if we are pre-disposed to health issues, yet we are quite far from being able to reliably create genetically perfect beings yet. In short, it is impossible for us to make any significant choices in our genetic makeup. In that respect discrimination based on genetic markers is on par with discrimination based on gender or race, so GINA is right in line with the spirit of the US constitution.
Re:And for good reasons... (Score:2, Insightful)
From a cost-benefit point of view, insurance isn't profitable for the people paying for it. It is profitable for the insurance companies. That's why they are able to exist under a capitalist system. If you have a 20% chance of getting sick instead of a 10% chance, the insurance company should have the right to charge you more, because they expect you on average (the mode is still near zero, but the mean is significantly higher) to be collecting more back from them.
Spreading everybody's risk to the collective instead of to the individuals is usually referred to as "socialism", not "insurance". I'm personally not a fan.
Re:Repeat after me, physician, (Score:5, Insightful)
Whether or not nicotine addiction is a disease is completely irrelevant. The issue is control and choice. Tobacco users had control and made a choice which led to them becoming nicotine addicts.
Saying "I shouldn't be discriminated against, because addiction is a disease!" is bullshit. It may be a disease, but you gave it to yourself because of your poor life decisions. It's like deliberately injecting yourself with the Ebola virus, getting Ebola, and then saying "it's not my fault I have Ebola symptoms! I have a disease! Don't discriminate against me!" It's like deliberately mixing radioactive waste into your food, getting radiation poisoning, and saying "It's not my fault! I have a disease!" And back in the 1950s you could (legitimately) plead innocence, but anyone who took up smoking after 1980 knew exactly what they were getting themselves into.
Comparing tobacco users to people with inherited disorders is bullshit. Tobacco users have a disease, if that's what you want to call it, because they made a stupid decision. A person with hemophilia inherited defective genes. One has a disorder because of something under their control, their decision to smoke. The other has a disorder because of something completely out of their control, the mixture of genes they inherited from their parents.
Re:Repeat after me, physician, (Score:2, Insightful)
I tend to favor the opinion of professionals over some random jerkoff on the internet.
If you've studied the issue for more than a decade and also have a legitimate reason for going against the consensus of your peers, I'd love to hear it.
Perfectly valid point. Now I don't need a decade of assumed "experience" trying to justify something I know not to be true but you still have not explained why you will BLINDLY believe something. Like the other posters I believe a citation would be required to back such a claim up. In fact, we can play your silly little game without the need for name calling which, btw, completely invalidates your claims- please cite 2 scholarly sources and at least 1 double blind study to back yourself up.
As a skeptic I require a little more than just what some association or group of labcoats says to make something true. What is the origin of this disease? What is the contagion? What is the claimed rate of survival and estimated rate of contraction?
Re:And for good reasons... (Score:3, Insightful)
And if you're concerned about safe drivers, you should argue for dismantling the auto insurance system altogether.
Except, even safe drivers have accidents, or have their cars struck by lightning while sitting in the driveway (true story!) and unexpected things come up with regards to peoples' health. Risk is always out there.
And risk carries a price! A 1% chance of getting sick or injured this year and needing $100,000 dollars in treatment is worse than a 100% chance of spending $1000 a year on insurance against that. Why? Because that first $1000 doesn't mean nearly as much to you as the last $1000 after you've exhausted your life's savings and your kids' college funds and gone into debt. You can plan for the first $1000. That's why it's worth it. That's why you'll even pay more than $1000 in this hypothetical case, to cover the insurance company's administration and make it a profit. That is how insurance works.
And to that end, it is good to discriminate based on real likelihood of disease. I know you want to protect the frail and the ill, and are more than willing to grab at the pockets of the eeeevil greeeedy faceless insurance corporations to pay for it. But it doesn't work that way: oh, sure, you'll grab a few thousands here and there, but it just ends up raising the cost of insurance for everyone, and when it gets down to that level it's a very regressive tax on society, as it affects the middle class and the poor much more than the rich, who can easily afford such hikes.
In essence, people who argue for equality in insurance are misled. They don't want that. They really want something like socialized medicine, plain and simple.
Re:First time Bush has posted something sane. (Score:3, Insightful)
Or prohibits those who rent, not own, their home?
Or prohibits those who play video games?
Maybe we should just prohibit coffee drinking.
It's a legal drug, just like cigarettes.
Re:Genetics is not a "lifestyle choice" (Score:5, Insightful)
STARTING smoking is a lifestyle choice - one which is often made at an age where you're too young and headstrong to know better. Continuing to smoke is not always a lifestyle choice.
As someone who is a smoker and has tried many times to quit, I do NOT feel that I have control over it without medical aids. That effectively puts it in the "disease" category (as another poster has pointed out). I do not CHOOSE to continue smoking, I simply continue to do it because I can't not do it. I know that some people quit smoking very easily, and then go on at the rest of us about how you just "need to be strong" and so on. That's a load of crap - the addiction is different in different people, and many of us could much more easily give up FOOD and WATER than we could cigarettes. The most extreme hunger and the most dire thirst are NOTHING compared to the craving I have for a cigarette if I don't have one every few hours.
I will very soon be seeing a doctor to get something prescribed, since the "over the counter" stuff helps somewhat, but not enough. I am fearful for my life, and yet still I light up. Tobacco addiction is a disease, and I would never wish it on anyone.
(I do apologise for this rather "personal" rant here, but I can't let this little thread pass as is - I fully expect flames and derision for my comments here from those who couldn't possibly know what it's like. I will happily read and perhaps reply to any sensible replies, but will ignore the flames, so don't bother trying to get a rise out of me)
Re:First time Bush has posted something sane. (Score:2, Insightful)
Re:Interesting vote... (Score:3, Insightful)
No, no, no, nonononono. That's the purpose of socialism. The purpose of insurance is to manage risk. Nobody here seems to understand this.
Is the purpose of your auto insurance so that you can pay for everyone else's bad driving when they have an accident? No. It's to manage the risk of your own driving.
And you pay a $120/mo premium when your average accident rate would only really cost you $100/mo because if you did get in an accident without insurance and had to pay hundreds of thousands of dollars, you could be totally and irrevocably Screwed for life, whereas you can presumably deal with terrible horrible burden of an extra $20 a month (that goes towards administrativia and profit) to avoid that.
Re:First time Bush has posted something sane. (Score:5, Insightful)
Public health issue? So they don't smoke in the office, nor anywhere except designated smoking areas, where us non-smokers will never go anyway. "They smell bad" is about as valid as complaining about your coworker's BO, both are issues that you have to sort out within your own office environment.
The problem with alcoholics is that being drunk precludes you from doing useful work, as well as being a disruptive force in the office. You cannot possibly make that case with smoking. A smoker is NOT impaired, nor is he disruptive unless he's puffing smoke in your face.
I cannot believe you're seriously suggesting discrimination against smokers "because they smell bad". What's next, not hiring the Indian dude because he smells like curry? Get real.
Ugh, age limits have NEVER solved ANY problems. Around here they keep raising the driving age, and accidents have never decreased. All they've done is have a bunch of 20 year-olds killing themselves in cars, instead of 16 year-olds. The smoking problem, drinking problem, and any other social ill is NOT solved by limiting access to the vice, it is solved from the root of it - cultural perceptions. Funny how France has no realistic drinking age, but alcohol abuse is a FAR smaller problem for them. It's all in the culture, m'boy.
Re:And for good reasons... (Score:3, Insightful)
I'm sorry, I don't really understand your reasoning for this. I understand the intent, and even somewhat can see the "emotion" behind it, but what I don't see is any logical explanation for it.
WHY do you have a right to be alive? WHY is this right any different to a "right to be looked after when you're sick" (health care)? How are these two things not simply granted by others? (your "right to life" only exists because other's accept that it does)
Note that I DO think you have a right to life, and I abhor the idea of a society that doesn't grant this right, but it most certainly is a societal thing, and not some mystical state of the universe that grants you this right.
Re:First time Bush has posted something sane. (Score:2, Insightful)
Re:First time Bush has posted something sane. (Score:4, Insightful)
Re:Repeat after me, physician, (Score:4, Insightful)
Re:You Liberals can thank yourselves for $4/gal. g (Score:4, Insightful)
In other words, we literally need to plan our communities to look more European. Any help convincing Americans to do that is much appreciated.
Re:Repeat after me, physician, (Score:4, Insightful)
I think the truth is that you will never accept as an authority any person or body that professes a view opposite to one you hold, regardless of experience or education.
Re:You Liberals can thank yourselves for $4/gal. g (Score:4, Insightful)
Re:Repeat after me, physician, (Score:2, Insightful)
The problem with smoking is that some people smoke a pack of cigarettes everyday. Anything in excess gives you cancer.
Re:Repeat after me, physician, (Score:4, Insightful)
Your argument seems to be that since they made a stupid decision, they should not be helped and left to fend for themselves. What about AIDS victims? Are you going to argue that since they had risky sex they should not be helped? Or what about people sick with malaria, they should have known better and settled where the mosquitoes don't fly? And what about the child that falls into a pit, should he have known better too? Where are you going to draw the line?
An addiction to nicotine is no different than one to alcohol or heroine or cocaine or any other addicting toxic drug: addicted people must be helped out of it, because that's the decent thing to do and because you also save society a few pennies by doing so. Making mistakes is a fairly common part of human life, and in the case of addictions such as smoking the main problem is in fact that people do not have complete control of their behaviour.
Re:First time Bush has posted something sane. (Score:2, Insightful)
Re:Repeat after me, physician, (Score:4, Insightful)
This whole thing comes down to some unanswerable determinism/free-will kinds of arguments. IMO, sick people should be taken care of and healthy people should do whatever the hell they want with their bodies. End of story. The whole argument about any substance 'abuse' comes down to some kind of sick puritanical moralizing and it makes me sad that in this day and age my actions are ruled by the same people who won't let actors say 'poop' on tv.
-bah
Re:First time Bush has posted something sane. (Score:3, Insightful)
As a member of Gen Y, who actually understands the incredible amount of liabilities the baby boomers (Gen Debt or Gen ME) has left my generation, I'm not so quick to point the blame to smokers for all life's problems.
In other words, that smoker who has already been taxed extra probably several hundred thousand dollars in their lifetime through BS cigarette taxes (spent to save the children, of course!) will almost certainly die much younger than the same non-smoker. And while paying for those lung cancer costs won't be cheap, it will absolutely be far cheaper than paying everything single one of the health costs for that same person who retires at 63 and uses benefits 'till they die of something else in their early 100's.
Re:First time Bush has posted something sane. (Score:2, Insightful)
Re:Why not just make this obsolete? (Score:3, Insightful)
As far as I can tell, a certain percentage of the population gets screwed by health care coverage whether state or private controlled. The only thing we're debating is by whom and by how much do people get screwed.
Re:First time Bush has posted something sane. (Score:2, Insightful)
That whole thing about how the war in Iraq was part of a business arrangement which enabled him to siphon public money into his buddies' bank accounts (handing lucrative contracts to rebuild the Iraq that he destroyed, to the chosen few) isn't a reason, is it? What would you call it though? purely so that we can define terms..
Re:You Liberals can thank yourselves for $4/gal. g (Score:2, Insightful)
They would be useful to me if the nearest bus stop to my house wasn't 5 miles away and buses ran more often than every 2 hours.
It is normal, for many Americans, as you just said. Efficient? Environmentally conscious? Maybe not, but it is pretty normal.
Re:Repeat after me, physician, (Score:3, Insightful)
But then almost all diseases are exactly that: a genetic propensity + environmental conditions. Even things we think of as '100% genetic' like cystic fibrosis. 100 years ago, most kids with CF didn't survive infancy. 50 years ago most kids with CF didn't survive their teens. 20 years ago most kids with CF didn't survive their 20s. Today many survive into their 40s or even later. Thats a huge positive impact exerted by the environment (i.e. a modern western one with access to advanced medical care.)
Re:Jame Watson has 32 "dangerous" genes (Score:2, Insightful)
Re:You Liberals can thank yourselves for $4/gal. g (Score:2, Insightful)
Re:Why not just make this obsolete? (Score:3, Insightful)
Re:First time Bush has posted something sane. (Score:3, Insightful)
You bring up all this "they can" stuff like it is some right. Well, for a private company, that might be true. But they can also not hire blacks who eat pork because the health risk increase, they can not hire whites who live near power lines because there is an increased risk of illnesses even though there has never been a link to the power lines. They can not hire people who play sports because there is an increased risk, they can not hire people who ride motorcycles because the chances of health problems stemming from an accident is greater then in a car. You know, because they "can" place a risk to anything that is legal, a company can make sure it only hires upermiddle class white folk and only the minorities that act white both at and away from work. And lets face it, that wouldn't be discrimination because they will hire the black people who act white, live in white neighborhoods and so on in order to reduce their risks and costs of insurance.
Like I said before, all of your concerns about extra costs to a smoker can be mitigated. There is no proof that a smoker will cost more in health care costs over their lifetime. Everyone dies of something, smokers just tend to do it sooner then non smokers. I have never seen a company that required you to take their insurance at your expense as a condition for employment so if the smoker doesn't take the insurance, they are in no difference of a state then they are without the smoker. I know lots of people who use their spouses insurance and forgo the company insurance because it is better or something. So while you want to justify what they can do in search for the almighty dollar, you might want to watch out for a situation where you won't have a job because nature hikes means people will twist their ankles and it might cost the company something more.
Employment is an exchange of value for a promise of value. Not some exorcise in cutting costs. You show up and provide value to the company, then then pay you in which you can buy something of value to you later. Nothing has ever shown that smokers are less productive the non-smokers and as long as it is a legal activity, nothing should be preventing someone from employment because of it unless it directly influences the company they are working for(or intending to work for).