In this paper we steer a course between two views of the value of equality that are usually understood as diametrically opposed to one another: on the one hand, the view that equality has intrinsic value; on the other, the view that equality is a normatively redundant notion. We proceed by analysing the different ways in which the equal possession of certain relevant properties justifies distributive equality. We then present an account of ‘basic equality’ that serves to single out where (...) this equal possession is really doing normative work. Our account departs from some common assumptions about basic equality but is nevertheless plausible in as much as it assigns to that concept a precise and normatively significant role in grounding the non-instrumental value of distributive equality. By showing when, exactly, equality is basic, we are able to explain both what is right and what is wrong in each of the two opposed views of the value of equality. The argument proceeds at a fairly high level of abstraction and is therefore applicable to a number of rival egalitarian theories. (shrink)

Temkin asks how we should distribute resources between the social determinants of health and health care; Sreenivasan argues that if our goal is fair opportunity, funding universal health coverage is the wrong policy. He argues that social equality in health has not improved under UHC and concludes that fair opportunity would be better served by using the resources to address the SDOH instead. His criticism applies more broadly than he claims: it applies to any argument for UHC based on health (...) equity. However, neither his strong causal conclusion nor his stark policy proposal is justified. I review methodological challenges for establishing the relative causal contributions of health care and social policy, concluding that we may never have a robust causal account to support a consequentialist choice. Fortunately, we may not need to answer the allocation question as a dichotomy. Given what Sen calls the multidimensional nature of health equity and the role of UHC in cost containment, UHC may not be a threat to health equity. I also argue against Sreenivasan's claim that the data he discusses should not trouble sufficientists and prioritarians. The worst-off are not simply lagging in improvement; rather, their health status is stagnating or worsening. (shrink)

It is a common view that benefits to the worse off should be given priority when health benefits are distributed. This paper addresses how to understand who is worse off in this context when individuals are differently well off at different times. The paper argues that the view that this judgment about who is worse off should be based solely on how well off individuals are when their complete lives are considered (i.e. 'the complete lives view') is implausible in this (...) context. Instead, it is argued that a pluralistic stance toward this issue should be accepted. This pluralistic stance recognizes that also the view that only focuses on how well off individuals are now and in the future (i.e. 'the forward-looking view') is relevant. The argument is based on appeals to intuitive judgments concerning who is worse off in different cases and reference to various underlying reasons why priority to benefits to the worse off is justified. (shrink)