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Mortal Peril: Our Inalienable Right to Health Care?
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Review
"A brilliant diagnosis." -- The Wall Street Journal
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About the Author
Richard A. Epstein is "one of the stars in the firmament of conservative intellectuals" (The New York Times Book Review). He is the James Parker Hall Distinguished Professor of Law at the University of Chicago, where he has taught since 1972.
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Product details
Paperback: 528 pages
Publisher: Basic Books; 1 edition (June 1, 2000)
Language: English
ISBN-10: 0738201898
ISBN-13: 978-0738201894
Product Dimensions:
6.1 x 1.2 x 9.2 inches
Shipping Weight: 1.8 pounds (View shipping rates and policies)
Average Customer Review:
4.0 out of 5 stars
5 customer reviews
Amazon Best Sellers Rank:
#2,025,942 in Books (See Top 100 in Books)
I read the korean translation of this book and though I disagree on the author's view in many aspects, I find this book really interesting as well as informative. So I decided to buy the english version of it. Not being american, I can't understand how americans manage to live in their healthcare system. Some radical arguments of the author are surely hard to struggle against.
Good
Richard Allen Epstein (born 1943) is a Professor of Law at the New York University School of Law, as well as associated with the Cato Institute, the Hoover Institution, and the Heartland Institute. He has written meny books, including Takings: Private Property and the Power of Eminent Domain,Why Progressive Institutions are Unsustainable (Encounter Broadsides),Design for Liberty: Private Property, Public Administration, and the Rule of Law, etc.He wrote in the Preface to this 1997 book, "This book represents my sustained effort to demonstrate that the source of our collective anxiety begins with the elaborate and counterproductive schemes of entitlements that live off the illusion of abundance of scarcity. It deals first with the grand question of health care... Alas, this book is not rich in quick fixes for intractable problems."He begins by stating, "The central thesis of this book is that the rules of the game as have just been laid out are more likely to lead to a sensible regime for the reform and regulation of health care than the dominant regime." (Pg. 19-20) He adds, "I think that the strongest theoretical argument in favor of a welfare right in health care, or anywhere else, is one that exploits the wedge between maximizing social wealth and maximizing utility." (Pg. 31)He suggests that "No political system will be able to turn people away once the coverage is made universal." (Pg. 55) Rejecting the notion that "everyone has a right to health care regardless of ability to pay," he asks, "Why is this principle appropriate for health care when it has been rejected for vacation homes and fast cars?" (Pg. 112)He argues that "Pay or play plans invite strategic maneuvering by employers... Employers with healthy work forces will choose to insure, so all the bad risk accounts are dumped into the public sector with insufficient funds to service them. The single-payer system prevents this strategy, but it invites abuse by a government monopoly that can stifle innovation, squeeze individual physicians, and operate in a slow and arbitrary way." (Pg. 188)He concludes with the suggestion, "perhaps we might be better off in a world with reduced costs and enhanced access, even if liability is sharply curtailed or totally eliminated... we need open markets, with fully enforceable contracts, no ifs, ands, or buts, to find the best levels of legal protection against adverse medical outcomes." (Pg. 416)Thought-provoking and controversial as are all of Epstein's books, this one is well worth reading, particularly given the renewed importance of health care in the current political debate.
A fiercely libertarian roommate of mine gave me this book to read, and I was pleasantly surprised to discover that it was about more than health care. The beginning is actually a good primer on common law, and an effective encapsulation of the philosophical foundations of libertarian thought. Epstein effectively cuts through the platitudes that have been shaping decades of largely ineffective government policy-the sanctity of every single human life, for example-and explains how accepting these commonplaces can lead to results that are worse for everyone.The section dealing with common law mostly discusses the distinction between positive rights and negative rights. Positive rights are those that grant a people the right TO something: liberty, for example, or the right to a decent standard of living. Negative rights give the people the right NOT to have something happen to them: infringement on their person or property, or unfair treatment by another party. Far from being a small semantic distinction (I'm sure all of us can think of how most laws could be stated in either positive or negative form) Epstein shows how positive rights are much harder to enforce, and generally lead to a variety of perverse consequences when we try. The rest of the book-dealing with the Clinton health care proposal, for example-has dated, but is worth reading for the application of these ideas.Epstein writes an elegant but dry sentence, with occasional jargon, and except for the times when he gets passionate, the book moves along at a stately plod: I had to reread several sections to make sure I understood them. But he is clear, and avoids the most intolerable feature of many libertarian thinkers: intellectual smugness. He understands that government welfare policies are generally motivated by noble impulses, and that the way to convince people isn't to jump around doing the I'm-so-smart dance, but to illustrate the difficulties of turning a moral imperative into a government edict.The part of the book I had the most trouble with was that dealing with charity. Epstein points out that private charity was doing an excellent job before the government stepped in and took the responsibility off the shoulders of the individual, who now felt (often) that he had done his part just by paying his taxes. In other sections, however, Epstein maintains that having government welfare discourages people from taking care of their own health, because they now realize that they have a safety net.Now, I don't understand how a government safety net would discourage people from doing this any more than a private safety net. Epstein could argue that a safety net based on private charity would be more selective, but in my experience this isn't true: a church asks fewer questions than the government. The biggest problem with Epstein's argument is that, if taken to its logical conclusion, it's opposed to the idea of any effective charity at all: anything that tells people that they have help if something bad happens to them will, to some extent, discourage them from trying as hard as possible to avoid that catastrophe.And not only charity, actually: this idea is technically opposed to the idea of many kinds of medical treatment. Doesn't the existence of angioplasty make people less worried about watching their weight, in the same way that the effectiveness of AIDS medication has made people less worried about contracting HIV? But I hardly think that anyone would want to stop research in these areas, even though the illness is - in most cases -the "fault" of the patient.Now, a world where everyone is completely responsible for his or her own lack of foresight might be better than the world we live in, but I doubt that many of us would be confident enough in our own judgment to opt for it - which is probably why we leave it up to the government, despite the usual results.
This might be a valuable book to read for someone who is involved in working towards the right to health care, as well as for opponents of all economic and social rights. The book's great weakness and dishonesty lie in omission of the relevant context of the author's opposition to all social systems of care (police and fire departments, public education, libraries etc.). The last 7 pages of the preface are all that most people need to read (not the other 500 pages). A one page summary and discussion of this book is posted at [...] click on Discussion -books .
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