Market justice views health care as an economic good delivered under free-market conditions. It assumes that markets are more efficient in allocating health resources equitably. The distribution of medical care services and access to them are determined by people's ability to pay. Social justice views health care as a social resource. It requires active government involvement in the delivery of health care under the assumption that the government is more efficient in allocating health resources equitably. Medical care is regarded as a basic right; all citizens have equal access to medical care; and ability to pay is inconsequential. Health care delivery in the United States is characterized as a quasi- or imperfect market. Hence, we find elements of both market justice and social justice, but the principles of market justice prevail. In some areas, the principles of market justice and social justice complement each other. In other areas, the two are in conflict. The principles of market justice and social justice complement each other with private, employer based health insurance for mainly middle-income Americans (market justice), and publicly financed Medicaid and Medicare coverage for certain disadvantaged groups and workers' compensation for those injured at work (social justice). The two principles collide, however, in regard to the large number of uninsured who cannot afford to purchase private health insurance and do not meet the eligibility criteria for Medicaid or Medicare. The two principles complement each other when private and government health insurance programs enable the covered populations to have access to health care services delivered by private practitioners and private institutions (market justice). Tax-supported county hospitals or city hospitals in large cities, public health clinics, and community health centers can be accessed by the uninsured in areas where such services are available (social justice). Conflict between the two principles of justice arises in smaller cities and towns and large rural sections where such services are not available.
