The recent proliferation of new data and technologies enables increasingly finer personalization of products and prices in every domain. In insurance, this revives and enlarges old debates around fairness that have never been completely settled. We will argue that the commonly accepted “actuarial fairness” as based on the “individual cost of risk” derives in fact from a conflation: while it indicates the average cost for a group of insureds from the perspective of an insurance company—and is therefore sound from a (...) business profitability viewpoint—it is arguable whether it represents the “fair price” for the individual insured. We first show in a historical perspective the intertwinement of conceptions of fairness with knowledge, in order to point to the alternative to actuarial fairness for insurance. We then describe the intrinsic difference between the insured and the insurer when underwriting an insurance contract. Finally, we build on this distinction to discuss the meaning of fairness in insurance prices. We thus hope to re-center the debate around insurance fairness on its underlying solidarity mechanisms rather than technical and actuarial considerations. (shrink)

Some argue that the concept of medical need is inadequate to inform the design of a universal health care system—particularly an institutional rather than a residual system. They argue that the concept contradicts the idea of comprehensiveness; leads to unsustainable expenditures; is too indeterminate for policy; and supports only a prioritarian distribution. I argue that ‘comprehensive’ understood as ‘including the full continuum of care’ and ‘medically necessary’ understood as ‘prioritized by medical criteria’ are not contradictory, and that UHC is a (...) solution to the problem of sustainability, not its cause. Those who criticize ‘medical need’ for indeterminacy are not transparent about the source of their commitment to their standards of determinacy: they promote standards that are higher than is necessary for legitimate policy, ignoring opportunity costs. Furthermore, the indeterminacy of concepts affects all risk-sharing systems and all systems that rely on medical standard of care. I then argue that the concept of need in itself does not imply a minimal sufficientist standard or a prioritarian distribution; neither does the idea of legitimate public policy dictate that public services be minimalist. The policy choice for a system of health care that is comprehensive and offers as good care as can be achieved when delivered on equal terms and conditions for all is a coherent option. (shrink)

The postwar welfare state provides social insurance against economic, health, and related risks in an uncertain world. Because everyone can envision themselves to be among the unfortunate, social insurance fuses self-interest and solidarism in a normative principle Friedman (2020) calls probabilistic justice. But there is a competing principle of status defense, where the aim is to erect boundaries between socioeconomic strata and discourage cross-class mobility. We argue that this principle dominates when inequality is high and uncertainty low. The current moment (...) is one of high inequality and high uncertainty, which results in intense status anxiety, yet does not rule out solidaristic solutions. Our contributions are to diagnose the causes of our current malaise, and to theorize the normative bases for the political choice facing contemporary western democracies. (shrink)