Politics, Philosophy & Economics, Volume 21, Issue 2, Page 165-189, May 2022. It is generally acknowledged that a certain amount of state intervention in health and health care is needed to address the significant market failures in these sectors; however, it is also thought that the primary rationale for state involvement in health must lie elsewhere, for example in an egalitarian commitment to equalizing access to health care for all citizens. This paper argues that a complete theory of justice in (...) health can be derived from a commitment to correcting market failure, or in other words promoting Pareto-efficiency, in the domain of health. This approach can address familiar problems around access to care, as well as problems related to resource allocation and rationing, the control of health care costs, and the foundations of public health. Egalitarian theories of justice in health cannot make sense of the depth and pervasiveness of state involvement in health and health care; only a theory rooted in the need to correct market failure can. (shrink)

This paper examines whether an agent becomes liable to defensive harm by engaging in a morally permissible but foreseeably risk-imposing activity that subsequently threatens objectively unjustified harm. It first clarifies the notion of a foreseeably risk-imposing activity by proposing that an activity should count as foreseeably risk-imposing if an agent may morally permissibly perform it only if she abides by certain duties of care. Those who argue that engaging in such an activity can render an agent liable to defensive harm (...) ground this liability in the luck egalitarian thought that we may justly hold individuals responsible for the consequences of their voluntary choices. Against this, I argue that a luck egalitarian commitment to holding people responsible cannot, by itself, ground liability to defensive harm. It can help ground such liability only against the backdrop of a distributively just society, and only if further considerations speak morally in favour of attaching certain well-defined costs to individuals’ risk-imposing choices. I conclude by suggesting that if an account of liability applies robustly across distributively just and unjust contexts alike, then what grounds an agent’s liability is plausibly not her responsibility for threatening objectively unjustified harm, but her culpability for doing so. (shrink)