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Book Review

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In the battle over the future of American health policy, the lines are drawn. On one side are those who seek to turn health care financing and delivery over to private markets that are individualized—where patients strike their own bargains rather than relying on employers or government insurers—and free from governmental mandates. On the other side are those who support a continuing role for government in assuring access to health insurance and health services and in controlling costs and monitoring the quality of care. The lines are hard, fast, and ideological.

The most recent skirmish ended November 24, 2003, when Congress finally passed a bill adding a prescription drug benefit to the Medicare program. The prescription drug debate became the latest cover for the ideological battle—should Medicare continue as a government insurance program with a defined benefit package or become a premium support program in which the federal government provides each beneficiary with a set sum of money to purchase fee-for-service care or a private insurance policy, HMO, or PPO plan?

In his latest book, Disentitlement? The Threats Facing Our Public Health-Care Programs and a Rights-Based Response, Professor Timothy Jost joins the ranks of those opposed to attempts to move American health care policy toward individualized, private markets. Published prior to the latest clash over Medicare, the book predicts the ideological debate and the philosophical divide. But where others describe the controversy from positions grounded in economics, distributive justice, utilitarian ethics, and public health, Disentitlement focuses on the role that law, legal rights, and courts play in forming and sustaining health systems.