Getting the Haves to Come Out Behind: Fixing the Distributive Injustices of American Health Care

Abstract:     
This article responds to a provocative article on American health policy by Professors Clark Havighurst and Barak Richman. Havighurst & Richman argue from a market-oriented perspective that the health care system is "rigged against the true interests of the political majority," and this "systematic exploitation of the majority by affluent minorities" is both a "breathtaking injustice" and a "extortion-like protection scheme."

Unfortunately, Havighurst & Richman don't say much of anything about concrete reforms they want enacted. Worse still, Havighurst & Richman don't say anything at all about how to get there from here. Both are important failings. Havighurst & Richman have plenty of company in ignoring the ways and means of policy, but their indictment isn't going to have the intended effects (or, dare one say it, any effect whatsoever) without a concrete plan for implementation.

Accordingly, my response offers a short "how to" guide for those interested in moving from diagnosis to treatment. It provides six rules of "hacking" derived from my time in Washington, and years spent watching hacks and wonks at play in the fields of health policy. Those who object to these rules, or to the tone with which they are described are, by definition, wonks.

Accepted Paper Series