An Ethical Evaluation of Health Care in the United States

Abstract

Four questions are widely thought to be crucial for evaluating any health care system from an ethical standpoint: (1) Does the system provide equal health care for all? (2) Does the system provide the best health care for all? (3) Does the system control health care cost effectively? (4) Does the system maximize free choice for both patients and providers? (see Engelhardt, this volume, p. 6). In this essay I first examine the meaning and presuppositions of each of these four criteria. I then argue that neither the first nor the second criterion is appropriate for the ethical evaluation of health care systems and suggest alternative criteria to replace them. Finally, I begin the complex task of applying the revised set of criteria to the ethical evaluation of the current U.S. health care system. One conclusion reached is that the extent of freedom of choice in the U.S. health care system, as well as the moral value of some forms of this freedom, have been greatly exaggerated.