A New Moral Vision for Health Care

Two major transforming realities have overtaken the health care systems that require us to redraw the health care map.

I. Taxpayers now fund approximately 50% of U.S. health care.
II. It is now inescapably clear that resources are limited relative to needs.

When limited funds meet unlimited demands, they must be budgeted and prioritized. The “rationing” of health care goes from outrage to obligation, from intolerable to inescapable. Those who distribute pooled or taxpayer funds become not mere payment agents but allocators of limited resources who must maximize the health of the group they cover.

There is a largely unexplored ethical analysis applicable to the macro-allocation of health resources. Those who allocate limited resources should not mechanically pay for everything within the doctor/patient relationship. As one perceptive author suggests:

“…the distinction between macro-allocation and micro-allocation of resources is crucial. More traditional bio-ethical analysis may well clarify the micro-allocation issues, but it is inappropriate at the macro-allocation level and therefore misses the point. …The allocation of health care resources is best understood as a political rather than an ethical issue.”

American health policy has missed a crucial point. Medical ethics may control the behavior of health providers, but it should not control the macro-allocation process. Public policy must have its own independent ethical duties. Welcome to the Brave New World of Health Care that is fast heading our way.