Access, cost, and financing: achieving an ethical health reform.

Three key ethical issues should inform the broader debate about health reform: (1) Why pursue universal coverage? (2) Why is cost containment an ethical issue? (3) What is fairness in financing? After examining these issues, we conclude that the core ethical values underlying each of these goals-including expanding opportunity, sharing burdens equally, and respect for persons-limit the means that can be pursued in health reform. Although national health reform will not accomplish all of the objectives of social justice, true comprehensive reform-even under conditions of political compromise-represents an important step forward.