Emanuel distinguished between basic services that should be guaranteed to everybody from discretionary medical services that are not guaranteed. The result would be a two tiered system, where those with more money could afford more discretionary services. He saw a failure to define basic services as the reason attempts at universal health care coverage have failed. As a result, the belief that universal health care would require unlimited costs makes any attempt at providing universal health care seem likely to end in national bankruptcy. Instead of universal coverage of basic health care, those who are well insured have coverage for many discretionary forms of health care and no coverage for some basic forms of health care. Emanuel said that while drawing a line separating basic and universal health care from discretionary health care is difficult, the attempt should be made. Emaniel mentioned the philosophies of Amy Gutmann, Norman Daniels and Daniel Callahan when arguing that there is an overlap between liberalism and communitarianism where civic republicanism and deliberative democracy meet. According to The Atlantic, Emanuel is describing the philosophy of John Rawls in arguing that society is choosing one value (equality) over another (a healthy society), and this substitution may be responsible for limited choices in health care. PolitiFact says that Emanuel was describing the fact that doctors often have to make difficult choices, such as who should get a liver transplant. PolitiFact also said, "Academics often write theoretically about ideas that are being kicked around. And they repeat and explore those ideas, without necessarily endorsing them."