An ethical obligation to ensure access to new medical technologies?

Because of health care's special status, society has an ethical obligation to ensure that all people have access to an adequate level of health care (including access to new technologies as well as existing ones), without facing excessive burdens in obtaining such care. Society's recognition and implementation of this obligation is all the more important because market forces, alone, will not produce appropriate distribution of health care resources. For those making decisions about resource allocation, ethical pitfalls can best be avoided if policy formulation is differentiated from clinical decisions about specific patients' access to care. The latter can and should be made by each patient's physician, but, to be effective, the former must be accomplished in broadly based political processes by both health care professionals and others. Further, decision making about access to new technologies should begin early in the research and development process, and should involve Medicare and other insurance carriers that will be called upon to pay for the technology. This course is highly preferable to waiting until the technology is ready for wide use--as is now common--and only then deciding whether to pay for it.