Needs, medical necessity, and the problem of helping the uninsured

The nature of health care, a multifaceted system of reimbursements, subsidies, levels of care, and trade-offs between economics, values and social goods, makes it both a problematic area of policy and critical to the well-being of society. In the United States, provision of health care is not a right as in some countries, but occurs as a function of a complex set of cross-subsidized mechanisms that, according to some analysts, exclude from coverage those who may be in the most need of it. Accordingly, this article examines some of the issues involved in making decisions on how to justly expand health insurance.