Well argued, as always. But I would say that the Covenant is better off not getting into HOW the countries should realize the respective rights, not least because it should be appropriate for all countries, rich, poor, western, socialist, etc. Just think about all the OECD countries with public doctors, hospitals and pharmacies who would be in breach with the Covenant if it said that public production and provision is only allowed when there are externalities or public goods! It is enough that it binds the counties to the goal of realization and to being serious about it. Then, cleaver economists and others can argue about implementation. Another, also interesting, problem is the extent to which the legal system should play a role in health provision. Many countries have tons of lawsuits where hopeful patients seek a court decision to get treatment, and Varun and others are researching if the court decisions get enforced when thry grant treatment. In Scandinavia the courts don't touch cases like that.