ABSTRACT
Recent figures show that more than 175 million Americans have job-based health insurance. 1 Thus, employers have considerable influence over the health of their employees, the nature and quality of the health-care system in the United States, and the levels of trust and social capital available to individuals and the community. Despite the magnitude of their influence, because of ERISA they have been relatively free from regulation with respect to the specific substantive benefits they offer their employees. As we saw in the last chapter, ERISA gives employers enormous discretion to decide what substantive benefits they include in employer health plans. 2 But the decisions that employers make when they choose benefits for their employees are as much rationing decisions in need of ethical analysis as are the rationing decisions that are made at the bedside by physicians, patients, and their families. Moreover, even strong discretion, of the kind employers have, is subject to ethical standards. In view of what is at stake here, including the health of individuals and our reservoir of social capital, only the highest ethical standards are appropriate.
