Richard Epstein's Mortal Peril: Ebenezer Scrooge meets the American healthcare system

Professor Henry Greely views Richard Epstein's Mortal Peril as a provocativ e, but ultimately failed work. It provokes with both its sharp analysis and its pointed language. Yet it fails in its goal of demonstrating the useful application of Epstein's first principles to the problems of access to hea lth care. Greely first argues that several of Epstein's chapters focus on the need to change the health care system to let people who cannot afford care die, wi thout providing empirical support for his claims about the costs of the cur rent system. He asserts that Epstein never assesses the possible benefits o f the programs he attacks, including the value in their correspondence to t he popular unwillingness to let people die for lack of money. He contends t hat Epstein's rhetoric about these deaths is harsh and likely counterproduc tive. Greely then contends that Epstein's examination of access to health care de livers far less than the sweeping assessment the book promises. Mortal Peri l fails to recommend specific reforms or describe, even in general terms, h ow the health care system would operate if its principles were adopted. Gre ely then constructs a health care system that he argues would meet Epstein' s principles. He claims that it would provide more health coverage for thos e who need it least, and less health coverage for those who need it most-a result both substantively and politically unacceptable. Epstein's first pri nciples, Greely urges, do not provide solutions to the problems of access t o health care and are, at best, irrelevant to them. Finally, Greely argues that the book's provocative premise, combined with i ts flaws, creates the danger that many will disregard future attempts to br ing the tools of economic analysis to bear on health care reform. To Greely , this danger is more real than the danger that Epstein's proposals will be followed by health care policy makers.