Treating the Least Well Off

To the Editor: In the Managed Care column on the mental health care system's obligation to the least well off in the October 1998 issue, Dr. James Sabin, the column editor, writes, "A severe weakness of the U.S. market-based system is that to date it lacks any guiding ethical vision." That statement is patently absurd. The market-based system is indeed guided by an ethical vision, although one Dr. Sabin and the authors may not agree with.

An enormous number of economic, business, political, and religious scholars believe the voluntary exchange of goods and services in a free-market economy, free from coercive government intrusion, is the most ethical and efficient way to distribute any commodity. And this body of thought certainly has more in common with our founding fathers, whom the authors misleadingly quote, than the ethical vision of coercive redistribution they outline.

Most of the current problems of cost and access that the article seeks to address are actually the result of interference in the health care marketplace. Allowing the market to perform optimally by decreasing the role of regulation and taxpayer subsidy would advance the very laudable goal of providing the best treatment to the most people, a highly ethical outcome.

If the column editor or the authors do not like the ethics of the marketplace they should attack them, but claiming they don't exist is either ignorant or arrogant.

Dr. Phillips is a fourth-year psychiatric resident in San Antonio, Texas.