These include putting health clinics in stores to reduce expensive emergency room visits, giving workers information about using health insurance and health care services . . .

These also raise concerns. Will a company health clinic automatically recommend the cheapest care, even if more expensive care is medically more appropriate? Will the information about what health insurance and health care services to use be untainted by the company's interest in keeping health insurance costs down?

We're getting into a dangerous area when employers begin to expand their role from health care purchasers to health care advisors and providers. Which interest will be put first--the employee's medical health or the company's financial health?

As a former owner of a staffing company, this issue is clear to me.

I'm not sure that this concern for discrimination will be that big of a deal because there is a clear guide set for what employers can and cannot do in making hiring decisions.  It boils down to one simple principle - If it isn't job related, you cannot use it to screen out candidates for a position.

This may cause concerned employers make more use of screening for the physical requirements of a job than in the past, but they will just have to make sure that those requirements are in fact job related.  That isn't a big jump.  Employment regulations already recommended that employers define those requirements along with some other requirements in the official job description.  In "office" positions the physical requirements are minimal, but conditions that interfere with job performance could be cause for not hiring an individual - such as inability to sit for long periods of time due to a back problem.  If a solution cannot be provided to aleviate that problem, then it could be used to screen out the candidate.  However, that would need to be defined somehow in the official job description.  In any case, that kind of candidate would probably not want a job that causes back irritation anyway. 

Unfortunately, the violators of these employment laws will come mainly from small business owners who don't know all the laws, and break them unintentionally.  What seems reasonable to them, may not be reasonable from the legal point of view.  The laws are getting so complex that a business owner practically needs a law degree to understand all their legal employer obligations.  Attorneys who act as advisors can rarely help the business owner anticipate every material situation they need to consider.  Take if from a former business owner that relied on advisors, and paid the price for it.

I don't think the DNA testing technology that is emerging would ever be legal to use for employment screening, as potential for a condition to arise that would interfere with job performance is not enough to screen out a candidate.  However, it is possible that access to those kinds of test results could bring up potential discrimination violations if employers access them before the hiring decision is made.  It certainly is going to cause discrimination in obtaining life and health insurances.  So the group insurance costs could be affected by such a test.  Employers will be put in a tough position, and may be forced to offer an insurance solution to those with "bad" DNA to keep healthier candidates from bearing the extra cost - unrelated to the employment decision.  Though, the current regulations don't accomodate employers in this regard yet, so everyone in the company will suffer if the insurance company doesn't offer individualized rates within the group.

We have seen employers require that employees not smoke--not even at home--if they want to keep their jobs. I think that has been allowed. If that really has been allowed, why not require employees to weigh less, exercise more, eat only approved foods, etc.?

I honestly think it's time to divorce health care from the employer. Let's allow employers to do what they really are best at doing--running a business. Let's leave healthcare to the government, to individuals, or to some combination of the two.

 I think Walmart sees how much these kinds of employees are costing them, and see the need to help them change their ways.  However, they seem to recognize how unlikely it is to get someone to change their habits.

I think even Ms. Chambers was too smart to think this sort of spin would fly.  

The Walmart memo was very clear about its aim: to cut healthcare costs for the company.  Nowhere in the memo was there talk about "social responsibility," or "encouraging people to make the right health choices."  Setting extra barriers in place to make it more difficult for a group of people to get jobs is hardly being socially responsible.  

Wal-Mart isn't excluding people with pre-existing health conditions, since most of those won't be covered and affect costs.

SFCWallace, the law no longer allows companies to exclude people with pre-existing conditions (or to deny coverage for pre-existing conditions).

I guess there's nothing necessarily "wrong" about a company hiring only white people, or only men, or only healthy people, or only Republican jack asses. It's just that if enough companies adopt such policies, it means a heck of a lot of people will be unemployed and on welfare (the majority in fact). Hope you can afford the tax bill.

Seriously, since we have this screwed up health care system, where employers provide health care, employers refusing to hire people because of their health status means not only a lot of unemployed sick people, but a lot of unemployed sick people without any health care (except Medicaid). That's a fiscal disaster for the country unless we abolish Medicaid and let the sick die in the streets.  

I think it's time to rethink the whole employer-sponsored health care system. Let's relieve employers of the burden--and come up with a substitute. And yes, it probably will be a government program, at least for the poor.

Got any real ideas?

WAL-MART: The High Cost of Low Price takes you behind the glitz and into the real lives of workers and their families, business owners and their communities, in an extraordinary journey that will challenge the way you think, feel... and shop.

Health care costs are a legitimate concern for a business.

But, health care costs should not be a legitimate concern for businesses. We are at this point because union contracts long ago included health insurance paid for, at least in part, by the employer. These contracts were negotiated when the cost of health care insurance was reasonable, but the rapid inflation in those costs have changed the equation for both the employers and the employees. The real problem we face is the cost of health care.

I am leaning very strongly to believing that health care should not be a profit making enterprise, but should be like a regulated utility. I am not yet sure just how to keep the incentives going for someone to research and develop improvements in medications and equipment in such a system. But, until we address the drivers of high health care costs I doubt that there will be a satisfactory means for providing it.

Of course any employer who is faced with the rising expense of providing health care insurance for his employees will look very hard for ways to control that cost. And, history tells me that the employers will find ways, most of which will not be acceptable to the rest of us.

Consider two categories. Overweight and aging employees.

I can tell you from experience that ageism is alive and well in the employment market. The potential employer merely has to present a plausible reason for not hiring (overqualified) and they are home free.

The same process can  be applied to overweight applicants. In some ways it already is.

I'm sure that statistical analysis of the health costs of verious other categories of people has already identified potentially expensive categories of people who should not be hired. Some employers already won't hire smokers. Since not being hired means not getting health insurance, this leads to a systemic increase in unemployment rates.

There appears to me to be two solutions for those people who are unemployed because of health risk. To the extent possible, unhealthy life styles have to be publicized and combatted (smoking for example.) Then the government will have to offer to insure the rest. The reason here is that the two causes of likely health costs are either those under the individual's control, or they are beyond that individual's control and require insurance to cover systemic risk.

Since an organized program of of reducing individual unhealthy life-styles requires organized systems to assist those people, that will also fall on the government. Essentially that removes the costs of individual health care from the employers and places it on society as a whole. The two categories for government are public health and government-provided heatlh insurance.

Ultimately all long-term chronic health problems will be given to government, and employers might insure against accidents. This is simpy more economically efficient for the nation.

Marysz is right about the underlying message here.  Chambers makes a big point about long-term workers being no more productive than new hires (which says a lot about Wal-Mart management!) and costing more.

Talking about poor health choices and personal responsibility ignores the class context for a lot of poor health.  Again, Marysz has it nailed.  Wal-Mart and other low end retailers make a fortune selling junk food at low prices.  People buying organic fresh fruits and vegetables at Whole Foods tend to be a lot more affluent than Wal-Mart employees. 

On the health insurance issue, the Wal Mart memo, the General Motors demands for UAW givebacks and a hundred other situations (e.g. a transit strike that started in Philadelphia today) do point to the end of the traditional employer-based health plan.

What's going to replace what we have now?

The Chambers memo's truly frightening aspect is the repeated insistence that Wal-Mart is on its way to earning a seat at the table for the national debate on the future of health care.

Chambers makes plain that Wal-Mart's real preference paralells the preference of President Bush expressed last year on the campaign trail.  She wants to move toward Health Savings Accounts with high deductibles and tax-deferred savings.  The front page of Saturday's New York Times business section plugged the same approach.

This "ownership society" approach to health care will create enormous problems for those who are older and sicker.

We need a social insurance approach (like Canada's or like Medicare coverage now for those over 65).  Everyone is covered, and the pool of risk is spread across the entire population.  Rashi Fein, one of the top scholars on health care, demonstrated years ago that competitive health insurance only works by selecting healtheir populations for coverage.

Health Savings Accounts could create a boon for financial service providers.  They may even help bring down health care costs by forcing sicker, older and poorer Americans to forego treatment. 

Wal-Mart has an agenda.  We need to keep fighting.

Jack Clark

I should clarify that HIPAA didn't completely outlaw not providing coverage for pre-existing conditions, it just placed so many limitations on when companies can exclude coverage for pre-existing conditions (and for how long), that most employers don't bother to include any pre-existing condition limitations in their plans anymore.  

HSAs are not necessarily a bad idea. The devil, as always, is in the details-- and few of their boosters seem concerned with providing those details. For HSAs to work to people's benefits, at least two conditions must be met: the HSA must be fully funded on the day it is started (the way FSAs are now-- the employer puts in the money up front and the employee's contributions are then deducted gradually from his pay over the next year) and the HSA must be paired with a major med policy which kicks in at the HSA limit, so there is no gap in coverage.

The subtext of Chambers' article is: how do we get rid of aging, overweight, female employees?

Huh?  I saw nothing about female employees in the memo that would justify that statement.  That is clearly discrimination and is illegal.  So is age discrimination.  Walmart knows better than that.  I love how people find it necessary to read their own agendas into this issue. 

The real "subtext" is - How do we deal with the rising cost of health insurance?

Jim, your point is well taken in that discrimination based on age and sex is illegal and pursuing discriminatory practices does open a company to risk of lawsuits. However, there are several things to consider:

Enforcement of discrimination laws has declined with a more conservative EEOC.

Courts are increasingly being stacked with unsympathetic (right-wing) judges.

It is fairly easy to do what Wal-Mart is proposing (re-writing job descriptions) to discriminate without actually having to explicitly exclude a protected class.

I'm not sure unhealthy people are a protected class, so discriminating against them may not be illegal (not sure of this).

The Wal-Mart memo does specifically recommend that Wal-Mart find ways to increase the percentage of healthy employees hired into the workforce. This is in fact clear discrimination in favor of healthy new hires and against unhealthy. And who are the unhealthy workers? Smokers, overweight people, aging people, and (if you consider pregnancy an issue) women.

This is all coming to a crisis point, and I just hope that someone really smart has input into how it changes.

CVille, I fervantly hope so too.

The question at hand isn't whether or not it's "necessary to do evil to make money," but whether or not Wal-Mart's proposed hiring practices should be classified as discriminatory.

It doesn't violate employment law, but may be an ethical and moral issue.  I don't think you can legislate morality.  If we all considered the ethics of this more carefully, we wouldn't need a new government program as a solution. 

the Wal-Mart memo doesn't "encourage personal responsibility."  It encourages Wal-Mart to do something to make more money -- more money for Wal-Mart, "personal responsibility" be damned.

That's is your opinion.  It isn't necessarily a fact.

I'm not sure unhealthy people are a protected class, so discriminating against them may not be illegal

I believe this is correct.

This is in fact clear discrimination in favor of healthy new hires and against unhealthy. And who are the unhealthy workers? Smokers, overweight people, aging people, and (if you consider pregnancy an issue) women

It is "discrimination",  any time you choose to hire a candidate you discriminate.  You must, or a decision isn't made.  It isn't illegal to prefer healthy people whom you can rely on to get the job done, as opposed to someone who you know will constantly have problems.  Nor is it fair to employers to require them to treat the sick as a protected class.  Being sick affects job performance.  If someone is likely to get sick, that is a legitimate hiring concern.  It is however, against employment laws to reject an applicant based on age, or sex, unless you can prove that it is a problem and directly job related. For example, if you are hiring actors and you are looking for someone to play a male character - you can di