Health policy comes to dispute over what the political community owes its members at the point where bodies, minds, and the proximity of death meet institutional structure. The framework's recognition tradition reads healthcare as constitutive infrastructure upstream of agentive participation (the floor at which the participants themselves are maintained in the constitutive vulnerabilities that make them participants) with profit-extraction at the floor structurally precluded, mental-health and substance-related conditions routed through care rather than punishment, population-scale public-health infrastructure treated on the same logic as the legal system, and the floor extended (in option-not-mandate form) to reproductive healthcare, therapeutic genetic medicine, and end-of-life autonomy for capacity-confirmed wellness-irretrievable cases. Three contemporary traditions in the classical-liberal lineage deny this framing at its premise from different directions.

The Friedman medical-licensure and consumer-directed-care critique (Friedman 1962, ch. IX; Friedman and Friedman 1980) presses two claims: occupational licensure of physicians produces monopoly rents that elevate cost without proportionate quality gains, and the insurance-against-catastrophe plus cash-purchase-for-routine-care architecture (the health-savings-account / consumer-directed-care form) delivers maintenance without bureaucratic intermediation. The framework's collapse of state-financing into state-provision, on this reading, misreads the actual policy space.

The Cato-tradition classical-liberal health-policy position (the Cato Institute health-policy work through Michael Cannon and successors; the comparative-health-policy literature reading the Singapore medical-savings-account architecture) presses the architecture claim: Singapore-style medical-savings-accounts with catastrophic-coverage backstop satisfy universal access without the single-payer monopsony that mainstream universal-coverage frameworks require. Framework critiques of privatized insurance overgeneralize, on this reading, from the United-States-style market-failure case to architectures that do not share its failure modes.

The Pauly moral-hazard analysis (Pauly 1968; the wide subsequent literature on cost-sharing as information-transmission) presses the consumer-incentive claim: zero-marginal-cost healthcare consumption (single-payer at the point of service) produces overutilization at scale, raising aggregate cost and crowding out genuinely needed care. Deductibles and copayments, on this reading, are not extractive features but information-transmission mechanisms.

The disability-rights critique of selectionist regimes in genetic medicine and end-of-life policy (Asch and Parens 2000; Saxton 2000; Kafer 2013; Garland-Thomson 2012) registers from a different political direction as cross-pressure on the framework's commitments: that the slide from threshold-permission to existence-selection is real, well-documented, and partly socially produced.

The categorical-against tradition on end-of-life autonomy (Kass on the wisdom of repugnance and the corruption of the physician's role; Pellegrino on the physician-as-healer commitment; the Catholic magisterial line through *Evangelium Vitae* (1995) articulating inviolable-dignity-of-life as a categorical commitment independent of capacity or wellness) presses two claims: that human life carries inviolable weight independent of its wellness or its capacity for agency, and that permitting medical assistance in dying (even under rigorous-process safeguards and even at the residual case the framework names) corrupts the moral substance of medicine and law and produces structural pressure toward expansion that procedural form cannot contain. The framework's wellness-not-bare-life commitment misreads what political life owes its participants under suffering, on this reading. The slippery-slope analytic tradition (Keown on the Dutch and Belgian records; Pereira 2011 on Belgium) supplies the empirical-track form of the same concern: rigorous-process safeguards in operating jurisdictions are historically liable to erosion through case-law expansion, professional-norm drift, and legislative drift, and the framework's residual-case derivation underestimates how much the apparatus tends to expand once installed. The strong-form disability-rights critique (Coleman and the Not Dead Yet tradition; Stainton; Saxton 2000; Garland-Thomson 2012; Kafer 2013) presses a partly-convergent and partly-divergent third claim: that legalized end-of-life regimes import structural pressure toward existence-selection-against-disability, that the competent-and-uncoerced framing presupposes a kind of agency that disabled subjects facing inaccessible material conditions and structural devaluation cannot exercise without distortion, and that no procedural safeguard can detect the structural soft-coercion such conditions produce.

The prohibitionist tradition on substance policy (DuPont's policy-track work; Sabet on the institutional-prevention case; Kleiman in the prohibitionist register on substance-specific harm escalation) presses one claim: that normalization of substance use produces population-scale wellness damage through use-rate elevation, dependence-rate elevation, and aggregate cost externalization, and that decriminalization or legalization regimes (whatever their harm-reduction architecture) produce systemic harms that prohibition's downside costs do not exceed. Treating substances on the alcohol-or-tobacco model under-counts the substance-specific harms, on this reading. The strict-libertarian tradition on substance policy (Szasz 1992 on the right to drugs; Block on the foundations of bodily autonomy) presses the symmetric counter-claim from the opposite direction: that any restriction on substance use, including the distribution-regulation the framework's three-layer architecture incorporates, is paternalistic intrusion on the user's bodily autonomy, that supervised-administration and maintenance regimes are soft prohibition, and that the political community has no standing to regulate what a competent adult ingests beyond the harm-to-others case standard recklessness doctrine already covers. The framework's three-layer architecture, on this reading, retains prohibition's substantive form at the distribution layer while gesturing at autonomy at the use layer.

The recognition tradition the section operates within reaches the constitutive-infrastructure-with-extraction-precluded destination on multiple independent grounds. The WHO social-determinants-of-health framework (Marmot 2004; WHO Commission on Social Determinants of Health 2008) locates aggregate health outcomes in upstream structural conditions rather than in downstream clinical inputs alone. The capabilities tradition (Sen 1999; Nussbaum 2011 on bodily-integrity as a central capability) supplies the structural-floor architecture: institutions are constrained to maintain bodily-integrity capability across the full population. Daniels (2008) reaches the just-health-distribution conclusion through Rawlsian fair-equality-of-opportunity reasoning. The Beveridge social-medicine tradition (Beveridge 1942; the NHS founding and its operational record) and the Bismarck social-insurance tradition (the 1883 German social-insurance establishment and its successor architectures across continental Europe) supply the two principal universal-coverage lineages along which contemporary OECD systems operate. The public-health-and-sanitation lineage (Snow 1855 Broad Street pump investigation; Chadwick 1842; Virchow's nineteenth-century social-medicine writings; the WHO smallpox-eradication record) supplies the population-scale-infrastructure case. The mental-health-as-healthcare reform tradition (the community-mental-health movement following Action for Mental Health 1961; the WHO Mental Health Atlas series; the Lancet Commission on global mental health) reaches the routing claim from independent premises. The harm-reduction tradition (G. Alan Marlatt on harm reduction; the Portugal decriminalization record from 2001 onward (Hughes and Stevens 2010; Greenwald 2009); the Swiss heroin-assisted-treatment program; the Vancouver Insite supervised-injection-site evaluation literature) grounds the substance-conditions-belong-in-care case. The reproductive autonomy tradition (Faden on biomedical ethics; the women's health movement through *Our Bodies, Ourselves* and successors; capabilities-based bodily-autonomy work) contributes the reproductive-healthcare-as-floor case alongside the *Roe v. Wade* (1973) and *Planned Parenthood v. Casey* (1992) jurisprudential lineage. The end-of-life autonomy lineage (the Oregon Death with Dignity Act 1997 operational record; the Netherlands Termination of Life on Request Act 2002; the Belgian 2002 euthanasia legislation; the Canadian Medical Assistance in Dying regime from 2016; the supporting bioethical work of Battin and others) provides the wellness-irretrievable-resourced-exit case under rigorous-process safeguards.

The dispute the section frames is whether healthcare obligation reduces to a financing-mechanism question (HSA-plus-catastrophic versus single-payer), a moral-hazard adjustment, or an architectural-design choice among framework-compatible coverage forms (theses pressed by Friedman, by the Cato-tradition Singapore-MSA literature, and by Pauly) or whether healthcare is constitutive infrastructure upstream of agentive participation with profit-extraction at the floor structurally precluded and the floor extended through reproductive autonomy, therapeutic genetic medicine, and end-of-life access for capacity-confirmed wellness-irretrievable cases, a thesis pressed by the Beveridge-Bismarck universal-coverage lineage and supported across the WHO social-determinants framework, the capabilities tradition, Daniels, public-health and harm-reduction operational records, and the rigorous-process end-of-life regimes. The disability-rights critique registers as ongoing cross-pressure on policy design within the recognition tradition rather than as a competing destination. [§9.10.2](<9.10.2 What is Required.md>) is where the structural-necessity derivation closes the dispute, tracing the chapter-opening (Awareness) / [§8.2](<8.2 Feeling.md>) (Feeling) / [§8.7](<8.7 Mortality.md>) (Mortality) grounding to what healthcare must deliver to count as healthcare under a political community whose participation conditions presuppose maintained, capacitated participants. *Thus the question stands disputed.*


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← [9.10 Healthcare](<9.10 Healthcare.md>) | [9.10.2 What is Required](<9.10.2 What is Required.md>) →
