Equality and Sufficiency in Health Care Reform

Gabriel Scheffler

Most Americans believe that health care is a right, not a privilege. Yet debates over health care reform frequently fail to distinguish between two distinct conceptions of the right to health care: one which focuses on sufficient access to health care—what I refer to as the Right to a Decent Minimum—and a second which focuses on equality in access to health care— what I refer to as the Right to Equal Access. These two conceptions of the right to health care in turn support two distinct categories of proposals for expanding health insurance coverage. The Right to Equal Access justifies a more radical set of reforms, such as Medicare for All, whereas the Right to a Decent Minimum justifies a more incremental approach to health care reform, such as by building on the Patient Protection and Affordable Care Act. Comparing these two conceptions of the right to health care to Medicare for All and the incremental reforms clarifies what it as stake in the debate over health care reform: not just concerns about political feasibility, but also different moral or political values. At the same time, it reveals that there are some surprising areas of convergence between these two conceptions of the right to health care, and accordingly, that there is room for greater convergence between these two types of reform proposals.