The purpose of this essay is to discuss the possibility of consensus between libertarians and egalitarian liberals on healthcare reform.  It will be argued that libertarians and egalitarian liberals would both find their goals met by deregulating the supply of healthcare.  Such deregulation would undoubtedly lower healthcare costs, resulting in less unmet need in healthcare.  This essay will conclude with some reflections on the effect of medical price information on liberal autonomy.

I. Finding Consensus with Egalitarian Liberals

Egalitarians liberals have deep convictions about the role of healthcare in justice.  For example, Norman Daniels has argued the egalitarian requirement of fair equality of opportunity demands that that each person enjoys “normal human functioning.[1]”  Thus those with disease and disability are entitled to a “fair share” of healthcare.[2]

Libertarian healthcare reform proposals often run afoul of egalitarian liberals.  The focus of libertarian reforms has been the passage of Health Savings Accounts (HSAs), which allows health savings to have the same tax-free status as employer supplied health insurance.[3]  However, HSAs have been criticized by egalitarian liberals.[4]  Among these criticisms is that HSAs do not help meet the medical needs of the unemployed or low income workers, and may in fact decrease financial equity.[5]  This issue represents a genuine impasse between libertarians and egalitarian liberals.  Egalitarian liberals think that there is an entitlement to healthcare, while libertarians deny any such entitlement.[6] 

Nonetheless, this impasse between libertarians and egalitarian liberals exists on the consumer or demand side of the healthcare market.  Consensus might be found on reforms that focus on the supply side of the market.  Rather than correcting for medical need by proving healthcare, egalitarian liberals could come to support reforms that prevent medical need.  Medical need could be prevented by deregulating the supply of healthcare.

II. Prioritizing Deregulation of the Supply of Healthcare

            The regulation of health care results in billions of dollars in expenses, resulting in an artificially high price of healthcare.  Christopher Conover has estimated that that the social costs of regulation in 2002 were $339.2 billion which, less the $170.1 billion in social benefits, leaves a net cost of $169.1 billion[7].  Thus regulation cost the average US household $1,546 in 2002 and accounted for 10% of US health expenditures.[8]

            As the supply of healthcare is deregulated, it will cost less to provide healthcare.  Such a supply shift would ultimately lower prices.  Faced with lower prices, the consumer will find health care more affordable.  If more people can afford healthcare, then they need not rely on government assistance to purchase healthcare.  Thus, medical need could be prevented by deregulating the supply of healthcare.

            Thus, egalitarian liberals can join libertarians and make the deregulation of the supply of medicine a priority.  Since deregulation will undoubtedly lower prices, the needy will be able purchase more healthcare.  This will result in less reliance on government funding while meeting medical needs.  Furthermore, those so impoverished as to still need government assistance will cost society less.

III. Information and Autonomy

            Liberals may also support deregulation in health care out of respect for individual autonomy.  In bioethics, the standard of informed consent respects patient autonomy by allowing the patient to make decisions that reflect their values.[9]  However, there is a class of information that has been excluded from patients: the price and quality of healthcare.

            Government’s encouragement of excessive coverage has resulted in little incentive for consumers to price and shop for healthcare.[10]  As a result, there is little information available to patients about the price and quality of healthcare.[11]  This information undermines the ability of patients to make informed decisions.  Thus, liberals can come to support deregulation since it will provide more information to patients, allowing patients to make autonomous decisions.

IV. Conclusion

            This essay has briefly dealt with issues in building consensus between libertarians and egalitarian liberals in healthcare reform.  Due to the egalitarian belief that justice requires the provision of healthcare to the needy, it is unlikely that consensus can be built on reforms for the demand side of the market.  However, deregulation on the supply side of healthcare will lower the price of health care, preventing unmet need from occurring in the first place.  Finally, deregulation may find more support form liberals generally when it can provide cost and quality information, permitting patients a more autonomous decision.