The legal recognition of the right to health worldwide has never been so advanced. At least 115 constitutions around the world have entrenched the right to health or health care, whether as justiciable claim-rights, aspirational guarantees, or a combination of the two. For advocates of the right to health, the path is open to create health systems that are more rights-respecting and more just. Yet others argue that its entrenchment leads to an expansion of judicial power and the introduction of incommensurable individual and curative claims in a necessarily utilitarian policy area. We suggest two questions to unlock this debate. First, what are the effects of justiciability on a healthcare system? Second, how do matters of institutional design change those effects? In this Article, we examine these questions by comparing the constitutional right to health in Colombia and South Africa across two decades. In Colombia, the right to health has grounded an elaborate structure of tutela-based litigation and a new consciousness of health entitlement. In South Africa, the right to health has supported limited judicial interventions for particular health outcomes only. In particular, we note how four variables: doctrine, judicial roles, private financing arrangements, and civil society lead to different version of what we characterize as “high-intensity” or “low-intensity” justiciability in the two jurisdictions.Far from leading inexorably to the expansion of judicial power, and to litigious, individualistic, and curative biases in health systems, the entrenchment of a justiciable right to health can instead produce only minimal litigation, private negotiations in the shadow of litigation, and civil society pressure for legal change. This contingency is revealed by close qualitative comparison.