The task taken up by this last chapter entails a review of the dominant and stable array of policy agendas arising from different interests and segments of the body politic. A pragmatic understanding of the policy priorities and arguments of the health care system’s key stakeholders is needed when considering any effort toward health care reform, whether incremental or fundamental. The Patient Protection and Affordable Care Act (ACA) is critiqued in accordance with the central principles of alternative theories of social justice, and its accomplishments, deficits, and prospects for survival as coherent social policy are then considered. The chapter concludes with a synopsis of an approach to health care reform that would satisfy the demands of justice articulated in the theory of John Rawls. In the U.S. health care system, one is “enfranchised”, or eligible, to receive nonstigmatized health care on the basis of health care insurance.
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The premise of this chapter is that relatively few students in public health, medicine, nursing, and social work have more than a superficial acquaintance with specific theories of social justice. It briefly describes five theoretical perspectives on positive rights to health and health care. As readers might have concluded by now, the five social justice perspectives considered in this chapter (libertarian, utilitarian, Marxist, liberal, and capabilities approach) indeed differ on their appraisal of health care as a basic right. Some theoretical perspectives go even further, by extending their arguments to entitlements or positive rights to not just health care, but to health itself as well. The chapter briefly summarizes these alternative theoretical perspectives on the right to health care, and then reviews the reasons for choosing the “Justice as Fairness” liberal theory of John Rawls as the optimal framework for the analysis of just health and health care policies.