Recidivism among alcohol offenders—drunken drivers in particular—has led courts to experiment with programs that attempt to rehabilitate problem drinkers. One such program, in El Cajon, California, offers defendants the choice of going to jail or of submitting to a year of treatment with Antabuse, a potent drug that reacts with alcohol to produce intensely painful physical symptoms. In addition, Antabuse subjects the recipient to the risk of toxic side effects.

According to the authors, the El Cajon program fails to inform defendants of the full risks and effects of Antabuse. Further, the authors maintain that the program uses the threat of a jail sentence to coerce defendants into consenting to Antabuse therapy. The authors conclude that defendants’ consent is so tainted by these factors that the program amounts to involuntary treatment.

Consequently, the authors suggest that the El Cajon program violates defendants’ constitutional right to privacy. Finally, the severity of the Antabuse-alcohol reaction leads the authors to contend that the program constitutes cruel and unusual punishment.

The American health care delivery system, and the attitude of the public toward that system, have undergone considerable change during the past two decades. According to the author, the belief during the 1960s that adequate funds were available to broaden access to health services, to enhance their quality and availability, and to support medical innovation, gave way during the 1970s to an awareness of limited resources, to a skepticism about the motives and competence of established institutions, and to a conviction that the system's problems were too complex to be solved easily, if at all. Moreover, the author states, the system has become fragmented and highly competitive; the respect formerly accorded both professionals and institutions has deteriorated; and the government's role in health care delivery is being challenged.

The result, the author says, may well be a paralysis of policymaking in health planning, as exemplified by the failure of both public and private institutions to achieve the cost-containment goals of the last decade, either through regulation or competition.

To gain perspective on these problems and to determine the direction of the health care delivery system for the 1980s, the author calls for a national health care debate. He suggests four concepts that should be included in such a debate, and recommends a new context of pragmatic idealism in which to conduct it.

Until recently, contractual relationships between health care providers and health insurers appeared to be immune from antitrust scrutiny. The Supreme Court ended this apparent immunity in Group Life & Health Insurance Co. v. Royal Drug Co., 440 U.S. 205 (1979), holding that insurance plans offering goods and services to policyholders are not exempted by the McCarran-Ferguson Act from the federal antitrust laws. By denying a McCarran-Ferguson exemption, the Court did not decide the ultimate issue—whether the insurers in fact had violated federal antitrust law.

This Note reviews Royal Drug in light of precedent and of the purpose of the McCarran-Ferguson Act. This Note contends that the result in Royal Drug follows logically and consistently from the Court's earlier readings of the Act, but that the Court's reasoning is unclear and, even under its strongest reading, unconvincing; hence, an alternative approach to interpreting and applying the McCarran-Ferguson Act is suggested. Finally, this Note analyzes the application of Royal Drug by lower federal courts and discusses its implications for the interface of health law and antitrust law.