 Personal medical services that are deemed essential to promoting fair opportunity for all must be accessible to all. Specifically, this will generally mean “universal coverage” through some form of public or private insurance for services deemed to be a “decent” or “adequate” array, as required by the appeal to the underlying concept of protecting fair equality of opportunity. There should be no obstacles—financial, racial, geographical, and so on—to access to the basic tier of the system. Determining what is in that basic tier must be clarified in light of arguments about how to protect fair equality of opportunity under reasonable resource constraints, and these arguments require a fair process (accountability for reasonableness) in which appropriate democratic deliberation can take place. The theory rules out arbitrary exclusions of whole categories of kinds of services that meet needs of the sort that should be met in the basic tier. Historically, for example, preventive services, mental health care, rehabilitative, and long-term care services have been excluded from both public and private insurance schemes, for various cultural and economic reasons. Most of these “categorical” exclusions are unjustifiable from the perspective of protecting normal functioning, but specific limit-setting choices can only be made through a fair, deliberative process.