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Editorials

Ethical Foundations of Health Care System Reform

Institute of Human Values in Health Care and Department of Surgery, Medical University of South Carolina, Charleston, South Carolina

^_* Address correspondence to Dr Sade, Division of Cardiothoracic Surgery, Medical University of South Carolina, PO Box 250612, 96 Jonathan Lucas St, Ste 409, Charleston, SC 29425 (Email: sader@musc.edu).

The first 300 words of the full text of this article appear below.

	Introduction

 
Arguments for reforms of the United States (US) health care system that favor central control and financing of health care have often relied heavily on ethical reasoning related to distributive justice. Advocates of reforming the health care system by decentralizing control and financing of health care, as have been advanced by the current Bush administration [1] and by the American Medical Association [2], seldom play the "ethics" card, yet, the reforms they suggest are also ethically sound. The term "Ethical Foundations" in the title of this editorial is plural, emphasizing that many different approaches to health care system reform are morally well grounded. The debate between John Goodman and David Himmelstein with Steffie Woolhandler on health care system reform in this issue of The Annals highlights the radically different programs for reform that are now near the top of the national legislative agenda [3]. It should be no surprise that the ethical foundations of radically different programs also may differ radically.

	A Spectrum of Health Care Services Reform

 
The health care system in this country is generally described as being in crisis because overall expenditures for health care are rising at an unsustainable rate, while tens of millions of Americans are uninsured or underinsured, suggesting that they lack access to health care. The constellation of problems associated with these observations has led to a sense of urgency in finding solutions. Himmelstein and Goodman hold nearly diametrically opposed views of the causes of the financial-access crisis, and their proposed cures are similarly opposed. Their views represent two ends of a spectrum related to degree of centralization of health care financing, one end marked by the idea that society must be responsible for providing health care to all, the other, by the notion that individuals must be responsible for seeking and paying for . . . [Full Text of this Article]

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This article has been cited by other articles:

				D. U. Himmelstein, S. Woolhandler, J. C. Goodman, and R. M. Sade Our Health Care System at the Crossroads: Single Payer or Market Reform? Ann. Thorac. Surg., November 1, 2007; 84(5): 1435 - 1446. [Full Text] [PDF]