ECONOMISTS, PUBLIC PROVISION, AND THE MARKET - CHANGING VALUES IN POLICY DEBATE

Among health services researchers, an ''economizing model'' of health care has eclipsed two traditional models, ''social conflict'' and ''co llective welfare.'' The older models emphasized social solidarity and distributive justice, but the newer one focuses on improving efficienc y, minimizing risks borne by third-party payers, constraining cost inc reases, and improving the functioning of markets. This article examine s one source of the economizing model, the work of several early and p ersistently prominent economists of health care, especially Mark Pauly , Martin Feldstein, and Joseph Newhouse and his colleagues at the Rand Corporation. in particular, it explores their role in transforming pe rceptions of health care from a set of special services into an ordina ry commodity, in giving currency to apparently dispassionate as oppose d to overtly value-laden analysis, and in according priority, among he alth services researchers and policy makers, to economists' traditiona l interest in fostering smoothly functioning markets. It exhibits thei r principal policy recommendation-income-graduated cost sharing-the so urces and character of their modes of analysis, and the character of t heir influence on policy makers. The article concludes that the suppos edly value-free economic analysis of health care rests on a cluster of values that inhibit the expression of social solidarity and the formu lation of policies intended to foster distributive justice.