Four issues

A just health-care system will protect the fair equality of opportunity of the members of a society. One implication of this view is that there is a social obligation to guarantee equitable access to a broad array of medical and other health-care services. Specifically, this means that various kinds of primary and other acute care must be available to people who need it, regardless of geographical location or ability to pay. The services we are obliged to provide may not just be more of what is already available in our system. Rather, new or different preventive and acute services may be what is needed to maintain and restore a person's normal functioning and thus satisfy the fair equality of opportunity principle. So too, certain social support services will count as health-care needs we are obliged to provide. These are, generally speaking, what just health care demands, and a careful examination of health-care systems in different countries would reveal what specific reforms are required.

But social obligations do not deliver health care: institutions and, ultimately, people do. These people must be adequately trained and equipped in the appropriate specialities, they must be where they are needed, and they must be willing to serve those who need them. If inner-city or rural residents lack adequate access, people must be moved to deliver appropriate care. If the elderly lack adequate primary care or social support services, people must be trained to provide it.