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In this EconTalk episode, host Russ Roberts welcomes historian Christy Ford Chapin to discuss her new book, Ensuring America’s Health. Lots of difficult questions were raised, most left unresolved. For example, how has the American health care system become so expensive and so fragmented and hyper-specialized? To what extent health care be subject to market forces? What should the role of the state be in ensuring adequate health care for its citizens?

1. Among the problems with the US health care system as it is today, Chapin says a big one is that “nobody really owns the patient.” What does she mean by that, and why does she consider this such a significant issue?
2. Chapin lays most of the fault for the inequities and inefficiencies in American health care today at the feet of the American Medical Association. What were the early goals of the AMA, according to Chapin, and why has their level of influence over health care declined relative to that of health insurance companies? How does this tangled history of interests explain the continuous rise in the cost of health care?

3. How is employer-based health insurance a subsidy to the middle and upper classes,” according to Chapin? What effect does this have on the cost and consumption of health care?

4. Chapin, while calling for significant roll-backs in state regulation of health care, also advocates a health care safety net. What do you think such a safety net would look like, and to what extent would you support a similar idea?

5. Toward the end of the conversation, Roberts acknowledges that prices can’t work in all health care contexts, though some sort of rationing or allocation scheme must still be necessary. Are we really left with a dichotomous choice- markets or the state? How can we know the best means by which to allocate health care?