How Many Libertarians Does it Take to Fix the Health Care System?

Abstract

The libertarian prescription for health care reform is a admixture of deregulation and purportedly utilitarian calculation of social benefits and costs. In Mortal Peril: Our Inalienable Right to Health Care?, Richard Epstein's offers a stark roadmap that embraces an unfettered free market for health care services, indigent care left primarily to the charitable impulses of providers and no cross subsidies between classes, generations or other categories of citizens (including the sick and healthy). This review essay argues that the history, economics, and politics of health markets belie Epstein's abstract reasoning. Though much of the argument in Mortal Peril is written in the language of economics and cost-benefit analysis, Epstein's core faith is libertarianism. The essay contends that Epstein eschews careful analysis of the economic complexities of health care markets in favor of simple principles that focus almost entirely on autonomy. It should be understood, especially by policymakers, that the resulting harsh policy prescriptions are not compelled by economic reasoning but by a set of arbitrarily chosen first principles.

Keywords: Health care, health care reform, managed care, libertarianism, cross-subsidies, EMTALA, charity care, health economics