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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.
- Sales Rank: #2606497 in Books
- Published on: 1997-03-24
- Original language: English
- Number of items: 1
- Dimensions: 1.63" h x 6.44" w x 9.47" l,
- Binding: Hardcover
- 528 pages
From Library Journal
Noted legal scholar Epstein challenges the right to universal healthcare, deriving his fundamental argument from his own interpretation of common law, the basis of American justice. Epstein argues that the system of rights and duties enshrined in common-law principles cannot be extended as obligations to provide care and assistance. He fears that state control of redistributive taxation threatens to shift entitlements from old to young and rich to poor and guarantees state support for a system of healthcare that, in the long run, may not provide an adequate structure for reform and regulation. Examined here are the notions of positive rights to healthcare, limited access, comprehensive care, and liability, particularly regarding the controversial topics of organ transplants and euthanasia. Well reasoned, scholarly, and controversial, this book is highly recommended for academic collections.?Mary Hemmings, Univ. of Calgary Lib., Alberta
Copyright 1997 Reed Business Information, Inc.
From Kirkus Reviews
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. -- Copyright ©1997, Kirkus Associates, LP. All rights reserved.
Review
Richard A. Epstein, a law professor at the University of Chicago, is one of the stars in the firmament of conservative intellectuals. He knows more about economics than most lawyers, doctors and health policy analysts. And health policy desperately needs the insights to be gleaned through economists' and lawyers' intellectual discipline. Mr. Epstein would seem ideally suited to the task of analyzing the nation's health care system--and in some ways he is. But Mortal Peril is a curiously uneven book, combining flashes of brilliant insight with commentary that may strike many readers as morally obtuse ... His thesis ... centers on "the mortal peril of beneficent regulation," the "unintended consequences" of high-minded schemes to guarantee access to health care.... The effort to transform charitable impulses and "moral intuition" into legal rights, like a right to health care, is, for Mr. Epstein, futile. He is a purist, and he does not want the Government to dabble in health care because, he says, "noble intentions quickly lead to an endless tangle of hidden subsidies, perverse incentives and administrative nightmares. -- The New York Times Book Review, Robert Pear
Most helpful customer reviews
28 of 31 people found the following review helpful.
Inspires agreement and argument
By Gulley Jimson
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.
0 of 0 people found the following review helpful.
A CONSERVATIVE/LIBERTARIAN CRITIQUE OF A "RIGHT" TO HEALTH CARE
By Steven H Propp
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.
0 of 0 people found the following review helpful.
Really interesting!
By Lee, Dongjin
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.
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