Is health care a social good, or is it a commodity? A trend to increase access to health care was initiated in the 1960s by the Social Security Act. The current prospective payment system has served to reverse the impact of the Social Security Act and has caused a clash between administrative and clinical decision makers. The physician’s traditional pledge to place the patient’s welfare first conflicts with the social reality of fiscal constraint, which is causing the rationing of patient care without public consensus. This article raises the issue of distributive justice in health care and points to the need for increased understanding of the nature of health care as a social good.