One can fairly infer from a series of Republican health-reform proposals over the years that the vision for U.S. health care driving their proposals has never been of an egalitarian system. Instead, their vision is a system in which every American has access to a basic, bare-bones package of health care, but one in which the generosity of insurance and of health care proper can be rationed by price and ability to pay, as are other basic necessities, such as food, clothing and housing.