Most Americans assume that universal access to health care is a desirable and humane political goal. Not so, says distinguished legal scholar Richard Epstein. In this seminal work, he explodes the unspoken assumption that a government-administered, universal health-care system would be a boon to America. Basing his argument in our common law traditions that limit the collective responsibility for an individual's welfare, he provides a political and 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. He also authoritatively documents the ways in which government regulation has actually reduced the availability of organs for vitally needed transplants, and has interfered with a sensible policy toward euthanasia.

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.

8 of 39 found the following review helpful:


In the Grand Libertarian Tradition, Omiting the Obvious  Dec 17, 2003 By D. B. Lazof
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 www.RightToHealthCare.org click on Discussion -books .