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)

In this review, I analyse how ‘behaviour-based personalisation’ in insurance – that is, insurers’ increased interest in tracking and manipulating insureds’ behaviour with, for instance, wearable devices – has been approached in recent social scientific literature. In the review, I focus on two streams of literature, critical data studies and the sociology of insurance, discussing the new insurance schemes that utilise sensor-generated and digital data. The aim of this review is to compare these two approaches and to analyse what kinds (...) of understandings, methodologies and theoretical perspectives they apply to so-called ‘behaviour-based insurance’. The critical data studies literature emphasises the exploitative aspects of these new technologies and mobilises behaviour-based insurance to exemplify the negative outcomes of digital health. Scholars from the field of the sociology of insurance empirically analyse the practices of behavioural-based personalisation and study how regulating and ‘doing’ insurance affect attempts to personalise it. I highlight the importance of approaching insurance as a specific financial technology and argue that more research is needed to understand the practices of developing behaviour-based insurance schemes and the insureds’ experiences. (shrink)