Most of the talk going on in Washington D.C. about a potential universal healthcare system seems focused merely on costs. With the estimated price tag hovering around $1 trillion dollars, it’s easy to see why. But there’s a real ethical component to a unified healthcare system that must also be considered. Ethical concerns raise important questions: Where is the line between citizen’s personal rights and personal responsibilities?

Much of the debate over ethics seems focused on the burden of older people on the young and the disproportionate amount of health care these two groups require. As the average age of people in wealthy countries increases, healthcare systems in general are pressed to provide adequate care and coverage. Some countries are forced to consider whether this kind of care is something that should be included in a public system or left to private insurance plans to cover. This may be a necessary sacrifice for an affordable national healthcare system.

And then there are problems directly connected to treatment policy. For example, the terminally ill often have little recourse in hoping for a miracle cure. While many drugs are on the market for a variety of symptoms and some can delay the inevitable, the patients’ prognoses generally don’t change. In national health systems like the one in the United Kingdom, public coverage doesn’t cover treatments considered to simply delay a fatal disease, however significant that delay may be. Any healthcare plan needs to determine the limits of coverage regarding the quality of life for individuals suffering from terminal disease and the funds to properly treat all citizens.

Experimental drugs also raise ethical questions. Who should foot the bill for a drug that no one is sure will work properly, and who should pay if it actually ends up hurting someone? Many healthcare systems avoid paying for experimental drugs. These systems argue patients could independently make payment arrangements directly with drug companies. But there may be a role for national health systems to pay into research for such drug tests. The government should be able to fund drug research, but it can’t be expected to foot the bill for drugs that are still in the early stages of research.

Other questions also become important when one factors in diagnostic treatments for citizens and the possibly long waits involved with universal healthcare, not to mention which treatments should be prioritized in a national healthcare system. It may be most beneficial to focus funding on preventative medicines and diagnostic procedures like colonoscopies and mammograms. With funding for health education and a means for everyone to catch diseases early in their development, costs for treatment should decrease dramatically. This kind of focus should also promote a more health-conscious population.

Besides simply the cost of medicine and medical care, what are the ethics of liability in a national health system? And how many sacrifices should doctors be making? The last two decades have seen a remarkable increase in the amount of money paid in domestic medical malpractice lawsuits. As such, malpractice insurance rates for physicians have skyrocketed, and that cost has been passed on to patients.

Meanwhile, primary care physicians have steadily earned far less than specialists who perform costly surgeries or treatments in a given field. As a result, fewer and fewer primary care physicians are around, according to the Robert Graham Center. Perhaps beside the insurance system for Americans, we need to consider capping the amount of money that medical malpractice lawsuits can make, while subsidizing less popular areas of medicine so that there is a sufficient number of doctors for all types of care required.

Whatever your opinions on universal healthcare or what a national system should look like, there are important questions of ethics to consider before making a leap of faith on any national health program. Sacrifices made for the health of a population should always be weighed heavily against the consequences for the few that may be left holding the bag. It’s this kind of discussion about the welfare of the country that should come before talks of cost and political viability.

Ben Caleca can be reached at calecab@umich.edu.

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