Incomplete Truths, Cost-Benefit Economics & Health

In the last eight years, some Americans have learned that pragmatic national political "security" decisions, unencumbered by moral or ethical considerations, leads to national malaise and international disrepute. This principle applies equally well to any proposal concerning our national health system. Health care expenditures deserve much more than economic cost-benefit analyses: they involve people's survival, lives, families' well-being, and a deep-seated American sense of fairness.

I eagerly read the October 23, 2008 New England Journal of Medicine articles by Victor R. Fuchs, Ph.D. ("Three 'Inconvenient' Truths") and Karen Davis, Ph.D. ("Slowing the Growth of Health Care Costs - Learning From International Experience"), both of which focus on the economics of health care and suggest directions to be taken (www.nejm.org - by subscription). Sadly, neither mentions the moral and ethical foundational questions which must be answered before the architecture for a new healthcare system plan is prepared.

When are we going to convene a serious national discussion of the moral and ethical principles (including goals, objectives, priorities and rules) which must underlie changes to our health system? Is it all economics, pragmatic decision-making and political gain, or will we work towards a health system that we can live with?