Many employers are combating healthcare costs with incentives, penalties and restrictive hiring policies, but at what price?

It's no surprise that healthy employees rely less on healthcare benefits, which makes them less costly to employ. Healthy employees use fewer sick days, which means greater productivity. Obviously, the ideal employee is a healthy employee.

Unfortunately, Wal-Mart's employees are not ideal. According to a 2005 memo available on the Internet from Executive Vice President of Benefits Susan Chambers, Wal-Mart's work force is aging faster than the national average, and its workers "are getting sicker than the national population, particularly with obesity-related diseases." She also noted a segment of Wal-Mart's work force "consumes healthcare inefficiently."

Wal-Mart is not unique in this problem. Many other corporations face similar healthcare-related challenges. So, what's the solution? Encouraging healthy lifestyles has become a popular approach. Many companies offer discounted memberships to health clubs and provide healthier food options in the company cafeteria. Also, company-sponsored smoking-cessation programs have become common.

Sure, these steps can help make current employees healthier. But what about future employees? Can organizations dissuade unhealthy workers from applying? What about going so far as to refuse to hire workers with health-related risks? Can a company refuse employment to an individual simply on the grounds that the individual is a smoker or happens to have a high body-mass index?

In Wal-Mart's memo, it outlined five "bold steps" to address rising healthcare costs. The memo suggested all jobs include some physical activity, such as cashiers doing some cart-gathering. "A healthier work force will lead to lower health insurance costs, lower absenteeism through fewer sick days, and higher productivity," the memo said. "It will be far easier to attract and retain a healthier work force than it will be to change behavior in an existing one. These moves would also dissuade unhealthy people from coming to work at Wal-Mart."

Other companies have gone to more extreme measures. In 2003, Michigan-based medical benefits administrator Weyco Inc. announced it would no longer employ smokers. The company offered smoking-cessation programs and other health incentives to employees, but those who smoked after Jan. 1, 2005, would be fired.

Weyco is not alone. Within the last two years, many companies have taken a stand on the smoking issue. According to news reports, Kalamazoo Valley Community College in Michigan stopped hiring smokers for full-time positions. Washington-based Alaska Airlines requires potential employees to take a nicotine test.

The debate is out on whether discriminatory hiring practices based on health concerns are legal.

Perhaps the danger lies in how far discrimination can go. What if an employee likes to have a few cocktails after work? What about those who participate in extreme sports? Are these employees risky and potentially costly hires?

Already, about 30 states ban lifestyle discrimination for private, legal behaviors. Given the response so far, it is likely that lifestyle discrimination will be illegal in most states.

However, the fact remains that many controllable factors influence overall health. All Americans should take responsibility for their health. Healthy habits promote a longer, more productive and higher quality of life - which is more valuable than any premium.