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The author first analyzes why the prevention of illness and promotion of health provide the leading justification for the government to act for the welfare of the population. His analysis focuses principally on the foundational importance of health for human happiness, the exercise of rights and privileges, and the formation of family and social relationships. He explains why health care, although critically important; is not the only, nor even the most important, determinant of health. Most morbidity and mortality in the United States is attributable to environmental conditions, pathogens, and human behavior, which are all more responsive to population-based interventions than to medical treatment.

Secondly, the author explores the importance of universal access to health care in achieving the health of populations. The number of persons in the United States without health insurance or with inadequate insurance is extraordinarily high and increasing, and this fundamentally inadequate access to health care services results in unnecessary sickness and death among large sectors of the population. Universal access to health care is justified not only by greater vitality among the currently uninsured, but also by social and economic benefits for all of society.

Third, he examines the importance of equitable access to health care. The distribution of health care services is highly inequitable, with persons in lower socio-economic classes and ethnic minorities receiving substantially inferior care. The author states that the inequity in the distribution of health care services not only lowers the quality of life among those receiving inferior services, but also renders them poorer and more dependent on society. Inequitable access to health care extends the already wide gap between rich and poor in the United States, with worrying social implications.

Fourth, the author explores the applicability of market theory and competition to health care services, stating that market theorists have the burden of demonstrating why a theory developed for consumer goods and services generally is applicable to health services that are essential to human flourishing. This burden is particularly strong when the empirical evidence shows that increased cost and inaccessibility have occurred in spite, and perhaps because, of competition in health care.

Publication Citation

39 St. Louis U. L.J. 7-43 (1994)