A hospital in Maryland has decided they’re not going to hire any more smokers. All applicants will take a urine test, and any tobacco, whether from dip, or cigars, or even vaping, will disqualify the applicant.

This kind of discrimination is illegal in about half the states, but Maryland isn’t one of them. The stated reason is to ensure new employees are demonstrating good health decisions for the patients. Current employees are grandfathered in. However, one can’t help but wonder whether increased insurance costs factored into the hospital board’s decision.

One of the biggest flaws in the American healthcare system is that employment and health insurance are linked. Obamacare could have and should have severed that link. It didn’t, and so you have situations like this. If not for employees expecting health insurance, no employer would have much incentive to discriminate against smokers.

That isn’t to say there would be no incentive. We’re talking about a hospital here. It’s kind of like a clothing store only hiring people who will wear the clothes. They’re providing better health, that should probably apply to their employees as well.

I’m not sure if I like the idea of workplaces using hiring discrimination to nudge people to make better health decisions. I dislike the idea of my workplace hiring based on what employees do outside of work. I once worked at a place which wouldn’t allow any smoking on the premises. Despite not being a smoker, I disliked inconveniencing the people who did smoke. However, ultimately, workplaces should be free to make their own policies around smoking and hiring and what’s allowed on their premises, whether we like them or not.

If this trend of discriminating against smokers in hiring decisions grows more widespread, smokers will have three options. First, they can stop smoking. Only about 18% of Americans use tobacco products regularly. The number has been steadily decreasing, and this kind of incentivization could see this number decrease even more rapidly.

Second, smokers can sue for legal protection. That’s what they’ve done in half the states, and what they may pursue in the other half. If they do, they’ll have the people on their side. Discriminating against smokers is pretty unpopular with the general population. However, that obviously infringes on the rights of employers to make hiring decisions based on their own criteria, however disliked those decisions might be.

The third, and in my opinion best, option for smokers is to fight to disentangle health insurance from employment. Again, this eliminates the biggest incentive to discrimination against smokers. Not only that, but it doesn’t infringe on anyone’s rights. But best of all, it solves a major problem with the American healthcare system.

Tying insurance to employment has first and foremost skyrocketed the cost of health care. Health care costs have zoomed above rates of inflation since the 1950’s, when wage caps and tax loopholes first caused employers to begin offering health insurance as part of compensation plans.

Employer-provided health insurance incentivises comprehensive plans. And what the employer-insurance tie didn’t do to incentivize comprehensive plans, the states did by mandating that plans cover everything from Viagra to breast implants.

Here’s how this works. Insurance means coverage for unpredictable, prohibitive costs. Comprehensive coverage means cost pooling for predictable, manageable costs. Insurance is car wrecks and cancer. Comprehensive coverage is pooling costs for a checkup. Cost pooling increases prices as consumers lose the incentive to comparison shop.

Smokers, the obese, people predisposed to genetic, expensive illnesses, and everyone else who is likely to be discriminated against because their care costs more than others’, but who still need a job, has every reason to seek to destroy the link between employment and insurance. And we’ll all be benefited from it.