Can a Health Care Market Be Moral?

This book fills a large gap in Catholic social thought by assessing the use of market ideas and practices in the delivery of U.S. health care. Based on her long experience as a lawyer and state representative in helping needy people receive medical care, McDonough presents a sophisticated and nuanced evaluation of the market in light of recent debates among health care economists. The market is not evil, she says, but the invisible hand touted by Adam Smith cannot handle the job alone--government must take a more active role in distributing medical care to all citizens in the U.S. Her arguments are grounded in Catholic social teaching--a tradition that recognizes the value of competition and the market but insists that government provide universal health care--and attend, first and foremost, to its neediest citizens. The first two chapters analyze Catholic social thought and health care; chapters 3 and 4 explore market approaches to health care; chapter 5 summarizes a "value dimension" approach to health care, promulgated by Daniel Callahan (McDonough's intellectual mentor); and chapter 6 offers a Catholic vision of health care, one that allows for some market mechanisms--viz., private insurance, managed care, and co-payments--within a larger framework of justice and concern for the least advantaged. Central to McDonough's thesis is that the market cannot be moral of its accord. And one of the first questions policy makers must ask is this: What kinds of values should guide decisions about health care? What exactly are the ultimate goals of medicine? Something has to give; the system can't accommodate unlimited care for all persons. The answers aren't easy or obvious, but they will involve a consideration of shared values and fundamental justice that heretofore have been absent in the debate.