ROBERT M. VEATCH
Right to Health Care
My task is to sketch out what an egalitarian account of justice looks like as it applies to health care, what conceptual and ethical problems it raises, and what its implications might be for a right to health care for the United States. 1 An egalitarian account is one that focuses on an interpretation of the moral principle of justice emphasizing some kind of equality, usually equality of individual well-being. This analysis shall suggest that an egalitarian account is one in which people are given opportunities for equality of well-being. This raises deceptively complex questions such as whether there must also be opportunities for equality of medical well-being, whether a second tier of "luxury" health care services could be purchased with discretionary funds, whether there is an objective standard for determining if people are equally well-off, and whether people should be permitted to trade away their entitlement to health care in order to buy goods in other areas that they value more highly. This analysis shall suggest that the emerging debate over global budgets provides a fruitful context for exploring these issues and that an egalitarian allocation of a global budget will look quite different from one devoted to maximizing the medical good done based on outcomes measures and cost-benefit analysis.
In the debate over justice and the right to health care in contemporary health care ethics two terms are controversial, rights and justice. The first is the use of the term right. Sometimes the starting point is to spell out certain characteristic obligations that tend to make actions right. These are often called principles. Justice is one such principle. The frame of reference is the one who is obligated to act in a certain way toward another. Rights-claims then derive from the