Millions of Americans lack health insurance, and as a result, thousands suffer and die every year. Philosophers have argued that an ideal society would avoid these problems by guaranteeing universal access to health insurance, but what about concerns that a universal health insurance system would be inefficient, create excessive fiscal risk, or impose excessive taxes or other personal costs? In , Alex Rajczi shows how defenders of universal health insurance can address the ethical issues raised by these objections and make the moral case for an American universal health insurance system that improves on the gains made in the Affordable Care Act. Engaging with these objections helps us uncover fascinating philosophical issues that have been previously overlooked. It also leads us to a deeper understanding of progressive and conservative views on distributive justice and provides us with a framework for examining debates about any part of the social safety net- in America and elsewhere.