Health reform and the goal-based approach

Here's Williams Hsiao (and others) discussing health reform as a means to an end, a very relevant issue in regards to Oregon's recent Medicaid experiment:

Our approach to such questions is based on looking at the health-care system as a means to an end... Our method focuses on the need to identify goals explicitly, diagnose causes of poor performance systematically, and devise reforms that will produce real changes in performance.  We will argue that reform must be strategic, based on honest means-end analyses of what is likely to happen in a particular national context.  Reforms need to be judged, not on reformers' intentions, but by the changes they actually produce.  

I was somewhat guilty of this in my opinions about the ACA.  Rather than argue for health insurance as a means to improve health outcomes or as a means to improve financial security, I often discussed health care as a right.  Maybe it should be a right, but why?  In creating good policy, this rights-based approach seems much less helpful than a goal-based approach.