A legal scholar's densely written argument that the good old days
of laissez-faire were better. Epstein (Univ. of Chicago) claims
that the welfare of the general population has been brought into
mortal peril by the assumption that a proper health care system
requires government controls. He traces the evolution of ideas of
rights from the common-law concept of negative rights (freedom from
the actions of others) to the more modern system of positive rights
- to life, liberty, the pursuit of happiness, and by extension to
health, housing, education, and other desirable ends. The latter
system, he complains, targets the state with duties of support,
builds in extensive taxation, and forces the redistribution of
wealth. In his view, the old common-law rules do a far better job
of providing health care than the present complexity of government
regulations with their many unintended and harmful consequences.
Thus, he sharply criticizes Medicare and Medicaid, with their
emphasis on expanding access and subsidizing services, and the
Clinton administration's failed health care proposals for further
broadening access. A defender of autonomy rights, property rights,
and contractual freedom, Epstein next focuses on specific areas in
which the state prevents individuals from doing what they want with
their bodies and their lives. His defense of baby-selling and
surrogate motherhood, his advocacy of a free and open market in
organs for transplant, and his arguments for removing the ban on
euthanasia and assisted suicide are sure to arouse protests from
many quarters. His thesis that an unregulated health care system
will ultimately provide better care and better access to greater
numbers of people is, if not disingenuous, certainly disputable.
(Kirkus Reviews)
In this seminal work, distinguished legal scholar Richard Epstein
daringly refutes the assumption that health care is a right that
should be available to all Americans. Such thinking, he argues, has
fundamentally distorted our national debate on health care by
focusing the controversy on the unrealistic goal of
government-provided universal access, instead of what can be
reasonably provided to the largest number of people given the
nation's limited resources. With bracing clarity, Epstein examines
the entire range of health-care issues, from euthanasia and organ
donation to the contentious questions surrounding access. Basing
his argument in our common law traditions that limit the collective
responsibility for an individual's welfare, he provides a
political/economic analysis which suggests that unregulated
provision of health care will, in the long run, guarantee greater
access to quality medical care for more people. Any system, too,
must be weighed on principles of market efficiency. But such
analysis, in his view, must take into account a society-wide as
well as an individual perspective. On this basis, for example, he
concludes that older citizens are currently getting too much care
at the expense of younger Americans. The author's authoritative
analysis leads to strong conclusions. HMOs and managed care, he
argues, are the best way we know to distribute health care, despite
some damage to the quality of the physician-patient relationship
and the risk of inadequate care. In a similar vein, he maintains
that voluntary private markets in human organs would be much more
effective in making organs available for transplant operations than
the current system of state control. In examining these complex
issues, Epstein returns again and again to one simple theme: by
what right does the state prevent individuals from doing what they
want with their own bodies, their own lives, and their own
fortunes? Like all of Richard Epstein's works, Mortal Peril is sure
to create controversy. It will be essential reading as health-care
reform once again moves to the center of American political debate.
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