In this chapter I will argue that the positive-rights view and the communitarian view should prefer MHI to NHI and that the popularity of NHI is no reason to think it is preferable to MHI.

Basic Rights and the Right to Health Care

It may seem obvious that NHI is better than MHI in providing citizens with a positive right to health care. NHI entitles all citizens to health care, while MHI entitles one only to services purchased using insurance or savings. Although everyone is required to purchase health insurance in a MHI system, MSAs are optional (except perhaps for the poor, depending on some proposals for MHI). Though the changes in the tax code will provide strong incentives for those with significant disposable income to have adequate MSAs, the poor will tend to have skimpy MSAs to purchase routine and noncatastrophic care. Thus, this issue seems settled.

But this argument moves too quickly. When we take a closer look, it turns out that if one thinks that there is a positive right to health care, one should not oppose MHI and may have some reasons to favor it.

The Content of the Right

To evaluate whether the arguments for a positive right to health care support NHI or MHI, we need to get clear about the content of this right.