Editor's note: Every Sunday, Fortune publishes a favorite story from our magazine archives. This week, we turn to a piece from 1985 about the burgeoning healthcare crisis. Who will pay -- to save lives, to keep families whole and employees working? Those were vital questions in the 1980s as national healthcare costs began to rise dramatically and technology made radical advances. Those are still vital questions today, of course. This piece shows how companies -- not doctors or patients -- began making major life and death decisions through their healthcare policies, sometimes for better, sometimes for worse. It is a fascinating preamble to this week's landmark decision on President Obama's healthcare law.
Companies are being pressed to pay for the latest, costliest medical care. It's hard to say no when an employee's child needs a kidney transplant.
FORTUNE -- Each new advance in high-technology medicine sharpens the debate over tortuous ethical questions -- who should receive treatment with these expensive new technologies, who should pay, and who should decide.
Increasingly the critical decisions are being made not by the government, doctors, insurers, or patients, but by those who pay as large a share of health care costs in America as the government does -- corporate employers. Executives at these companies don't relish confronting the painful questions, but they can't avoid them. In the U.S., corporate spending on health insurance has almost doubled since 1980, to about $90 billion a year. That has thrust corporate America into a new role as health care policymaker.
''Corporations are being asked to play God with money,'' says an official at one FORTUNE 500 company. ''It's a brutal issue -- the most sensitive thing companies have had to deal with in employee relations. Our employee benefits man walks around here with bags under his eyes.'' Should the company pay for controversial and extraordinarily expensive procedures that may prolong life only for a short time? Should it pay for a liver transplant that costs up to $240,000 but keeps most adult recipients alive for less than a year?
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