MORTAL PERIL.

• Author: Marmor, Theodore
• Position: Review

MORTAL PERIL Our Inalienable Right To Health Care?

by Richard Epstein Perseus, $18.00

RICHARD EPSTEIN IS AN IDEOLOGICAL zealot who writes clearly and a devotee of 19th-century classic liberalism who thinks a one-size-fits-all philosophy is adequate for every and any subject. In the case of Mortal Peril, which will soon be released in paperback, and which his publishers hope will create a stir in a renewed debate, the victim is medical care: a subject more resistant than most to an ideological straightjacket.

Epstein begins by going to extraordinary lengths to argue that citizens should not enjoy the right to medical care. He believes in the centrality of property rights and the virtues of allocating any good or service by willingness and ability to pay, nor does he grant any exceptional status to health, illness, or medical care. In his words, the "major question is: Why is this principle [of equal access] appropriate for health care when it has been rejected for vacation homes and fast cars?" From here, Epstein goes on to criticize the notion of a positive right to medical care as not only philosophically questionable, but economically inefficient and administratively impossible. He questions whether medical care is all that important for health and argues that economic growth (and wealth) explains most of the improvements we foolishly ascribe to modern medicine.

Having made that set of claims, Mortal Peril then takes a tour across the vast domain of American medical care. Medicare, he finds foolish. The Clinton health reform plan he regards as idiotic. And the utilitarian and contract enforcing claims he makes for active euthanasia and physician-assisted suicide are not very different from the case for selling body organs. What links these views is the claim that we own our own bodies and that markets (and contracts) are devices of "voluntary exchange" by which the "greatest good for the greatest number" is achieved when supported by the willingness to recognize and enforce contracts. Although no one else has so boldly presented Epstein's utilitarian premises, the clarity of his presentation has the countervailing result: it makes the flaws in his prescriptions and scholarly standards obvious.

The fundamental flaw is that the evidentiary basis of this book is that of a legal brief. To take the area I know the best, Medicare, one clearly sees the triumph of ideological conviction over serious scholarship. To understand the origins and...