Foundational Ethics of the Health Care System The Moral and.pdf

Journal of Medicine and Philosophy , 33: 461–497, 2008 doi:10.1093/jmp/jhn023 Foundational Ethics of the Health Care System: The Moral and Practical Superiority of Free Market Reforms ROBERT M. SADE Medical University of South Carolina, Charleston, South Carolina, USA Proposed solutions to the problems of this country’s health care sys- tem range along a spectrum from central planning to free market. Central planners and free market advocates provide various ethical justifi cations for the policies they propose. The crucial fl aw in the philosophical rationale of central planning is failure to distinguish between normative and metanormative principles, which leads to mistaken understanding of the nature of rights. Natural rights, based on the principle of noninterference, provide the link between individual morality and social order. Free markets, the practical expression of natural rights, are uniquely capable of achieving the goals that central planners seek but fi nd beyond their grasp. The history of this country’s health care system and the experiences of other nations provide evidence of the superiority of free markets in reaching for the goals of universal access, control of costs, and sustaining the quality of health care. Keywords: bioethics, central planning, free markets , health care reform, health care system I. INTRODUCTION Nearly everyone agrees that the fi nancing and delivery of health care in the United States is immensely dysfunctional. A broad range of facts is usually marshaled to illustrate the problems. A substantial proportion of U.S. citizens— 47 million (15.8 percent)—lack health care insurance (Chockley, Pirani, and Kushner, 2006). A recent survey