The Neoconservative Health Strategy

Vouchers and the Rhetoric of Equity
  • John Arras
Part of the The Hastings Center Series in Ethics book series (HCSE)


A new medical conservatism has emerged from the health care politics of the last decade. In both style and content, this movement bears little resemblance to the old politics practiced for so many years by the American Medical Association (AMA). The spokesmen of that earlier era tended to be uniformly strident, uncompromising, and fiercely ideological in their defense of the status quo. By contrast, the proponents of the new conservatism are consistently moderate, conciliatory, and pragmatic. Since most of them are university-based scholars rather than physicians, their writing tends to lack that element of intense and often hysterical self-interest that characterized their predecessors’ style. The content of their proposals reflects this spirit of reasonableness and accommodation to the modern world. For example, they unabashedly proclaim the need for National Health Insurance (NHI) in one form or other; they criticize fee-for-services arrangements in favor of prepaid group practices; and they even chide the medical profession for preaching a flinty capitalism while enjoying the fruits of a cushy monopoly. As sociologist Paul Starr wryly notes, the “socialized medicine” of one era has become the corporate reform of the next.1


Health Plan National Health Insurance Health Maintenance Organization Urban Poor Consumer Sovereignty 
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    For an excellent general account of neoconservatism, see Peter Steinfels, The Neocomervatives: The Men Who Are Changing Americas Politics (New York: Simon & Schuster, 1979). A short list of prominent neoconservative health policy theorists includes Paul Ellwood of Interstudy, a research institute of Minneapolis; Alain Enthoven, an economist at the Stanford Graduate School of Business; Charles Fried, a Harvard law professor; Clark Havighurst, professor of law at Duke; the late Reuben Kessel, formerly of the Graduate School of Business, University of Chicago; and Martin Feldstein, a prominent conservative economist from Harvard. Although Feldstein’s views are influential in health policy circles—and would have to be carefully studied in a more comprehensive project— his Major Risk Insurance plan relies so heavily on deductibles and coinsurance that it practically guarantees an inequitable outcome for the poor and near-poor. Since equity in health care is the primary concern of this essay, I have chosen to concentrate on those theorists who at least regard the achievement of equity as a serious policy goal.Google Scholar
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Copyright information

© The Hastings Center 1983

Authors and Affiliations

  • John Arras
    • 1
    • 2
  1. 1.Department of Social MedicineMontefiore Hospital and Medical CenterBronxUSA
  2. 2.Barnard CollegeColumbia UniversityNew YorkUSA

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