Healthcare is of central importance to all communities and generally has a high political profile. Access and availability of care, rising costs, and emerging new relationships between experts (doctors and nurses) and users (patients, citizens) pose new challenges. ICT-based innovation is often proposed as a solution, accompanied by optimistic accounts of its transformative potential, both for the developing world and the developed. These ambitions also implicitly endorse new social agreements and business models. In this respect, as in others, technology is not neutral or simple in the service of modernization; it has its own politics. This paper discusses ICT innovation in healthcare in these terms focused on issues of sustainability and responsibility adapting two economic concepts: redistribution and externalities. The analysis reveals ICT innovation in health care as essentially raising ‘trans-scientific’ questions – matters of policy and intergenerational ethics rather than narrow science