Health care has been a hot topic within the United States for over a decade. Despite the many changes that have taken place, health care—and more specifically, versions of what have been termed “managed care”—continues to be a subject of intense debate and ongoing change. Whether the discussion is about access to care, quality of services, costs of care, or strains in the health care provider-patient relationship, a wide variety of stakeholders (e.g., patients, health care providers, health care organizations) have expressed frustration with the health care system. One of the central rallying cries behind the debate about health care is concern about the influence of “business” on health care. This special issue emerges out of the recognition that health care remains in flux, that health care continues to be a controversial subject among a wide array of stakeholders, and that the influence of business on health care is a key underlying source of tension.

Part of this debate has to do with what constitutes a just health care system. On the one hand, people in our society want to have access to high-quality care. More specifically, they want to be able to utilize the latest technology, care that is available when they need it (especially in crisis), a highly skilled care provider they can trust and develop a relationship with, and to not have to wait to gain access. On the other hand, people want a health care system they can afford. They want a health care system that is efficient, that offers reasonably priced services, and that doesn’t unduly strain the financial resources of families or the state.

This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory’s focus on ethics, without recognition of the effects of incentives, severely limits the theory’s ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering.

In this paper we highlight the emergence of organizational ethics issues in health care as an important outcome of the changing structure of health care delivery. We emphasize three core themes related to business ethics and health care ethics: integrity, responsibility, and choice. These themes are brought together in a discussion of the process of Mission Discernment as it has been developed and implemented within an integrated health care system. Through this discussion we highlight how processes of institutional reflection, such as Mission Discernment, can help health care organizations, as well as corporations, make critical choices in turbulent environments that further the core mission and values and fulfill institutional responsibilities to a broad range of stakeholders.

This article examines the ethical issues raised by the pricing of priceless goods. Priceless goods are defined as ones that are widely held to have some special non-market value that makes them unsuited for buying and selling. One subset of priceless goods is prescription drugs—particularly life-saving and life-enhancing ones. Drug makers are under pressure to price their medicines responsibly, which means to restrain their prices (and profits). However, this article argues that it is precisely because life-saving and life-enhancing medicines are priceless that it is especially urgent to leave companies free to charge market prices for them.

This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.

It is not too early to suggest that the attempts to place medical care in private hands (through group insurance arrangements) has not fulfilled its promise—or better, the promises that were made for it. Yet history has not been kind to plans to make government the single payer, and the laudable progress in medical technology has placed high-technology medical care beyond the reach of most private budgets. In this paper I suggest that the major problem of the U.S. health care system as presently conceived is a failure of legitimacy, and I put forward a proposal that purports to solve that problem. The proposal is to localize health care, on the model of a public school system, on the argument that such localization will answer most of the questions of legitimacy at the core of the private insurance imbroglio, provide a brake for medical costs, while preserving our ability to take advantage of the most advanced medical interventions. I present some initial arguments for the proposal, but await its proof in the dialogue emerging as the present insurance system collapses.