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March 11, 1998

Articulating a Social Ethic for Health Care—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(10):745-746. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-10-jac80000

In Reply.—Only Mr Epstein answers my pointed question forthrightly; Dr Lindsay and Dr Lally beg the question with sermons.

Epstein considers it perverse to give more health care to poor children than to rich children whose parents can help them avoid illness or injury. To call giving disenfranchised children the health care that their parents cannot or neglect to give them a "deviation from what is considered right and good" (the meaning of "perverse") reflects his distinct social ethic and de gustibus non estdisputandum. I wonder how many other Americans share that ethic? As to his query as to why redistributing wealth through health care is preferable to a full-scale but destructive redistribution of wealth, one answer is this: targeting subsidies narrowly on health care to avoid acute human suffering or stave off early death requires much less redistribution.

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