Health Care, Markets, and Democratic Values

Proposals to restructure the health care industry by increasing market competition currently have much political and academic momentum. Whether such proposals will work necessarily depends in part upon the criteria for success that are applied. Viewed from the market perspective, the question is whether procompetitive reforms will achieve their stated goals of containing costs, increasing efficiency, and enhancing consumer sovereignty over health care decisions. From a broader perspective, other questions are also of concern: whether increased competition in health care will actually improve people's health, and whether the operations and effects of health care competition are consistent with important values such as individual dignity, democracy, and equality.

These questions need to be seriously addressed, if not finally answered, before the federal and state governments embark on a policy of widespread market reform. To contribute to the resolution of these issues, this Article briefly surveys the market advocates' articulated goals and their somewhat disparate means for achieving them. The Article then argues that the major market proposals are flawed seriously by internal contradictions, so that in all likelihood they will not be able to realize their goals even if their assumptions about human nature and the consumption of health care services are accepted.