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To the Editor: The term market justice in the Commentary by Dr Budetti¹ conflates 2 distinct conceptual constructs—that of justice with that of insurance. Markets make no claims to justice. They are vehicles for allocating resources among mutually self-interested parties under conditions of scarcity. Within certain specific conditions, markets are efficient; that is, they result in a distribution of resources at equilibrium such that no one can be made better off by changing the distribution without making someone else worse off.²

The specific attributes of health care markets that militate against this desirable outcome are well described and are principally associated with the existence of risk and uncertainty.³ Insurance is a mechanism to protect risk-averse individuals against uncertainty and, as such, it can exist in a nonregulated market, in a regulated market, or as part of a government-sponsored program. Individuals purchase homeowners' insurance to protect themselves not against the "market . . . [Full Text of this Article]

Andrew D. Racine, MD, PhD
aracine@montefiore.org
Department of Pediatrics
Albert Einstein College of Medicine
Bronx, New York

Theodore J. Joyce, PhD
Department of Economics and Finance
Baruch College
City University of New York
New York, New York

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