Health, Luck, and Justice is the first attempt to systematically apply luck egalitarianism to the just distribution of health and health care.

Equality is a key concept in our moral and political vocabulary. There is wide agreement on its instrumental value and its favourable impact on many aspects of society, but less certainty over whether it has a non-instrumental or intrinsic value that can be demonstrated. In this project, Shlomi Segall explores and defends the view that it does. He argues that the value of equality is not reducible to a concern we might have for the worse off, or to ensuring that (...) individuals do not fall into poverty and destitution; instead he claims that undeserved inequalities, wherever and whenever we might find them, are bad in themselves. Assessing the strength of competing accounts, such as sufficientarianism and prioritarianism, he brings together for the first time discussions of the moral value of equality with luck- or responsibility-sensitive accounts of distributive justice. His book will interest readers in political and moral philosophy. (shrink)

Egalitarians have traditionally been suspicious of equality of opportunity, but recently there has been a sea-change in thinking about that concept. Shlomi Segall brings together these developments and offers a new account of 'radical equality of opportunity', which removes all obstacles (to one's opportunity-set) that lie outside one's control.

The article argues that discrimination is bad as such when and because it undermines equality of opportunity. It shows, first, that other accounts, such as those concerning intent, efficiency, false representation, prejudice, respect and desert cannot account for the badness of discrimination as such. The inequality of opportunity account, in contrast, captures everything that is bad about discrimination. The article then addresses some counter-examples of practices that are discriminatory without arguably entailing inequality of opportunity, where the notable case is that (...) of segregation. It is further demonstrated that the account successfully handles some of the tricky aspects associated with discrimination, such as those concerning the confinement of discrimination to salient groups, discriminatees by means of financial compensation, in the selection of life partners, and the duties of employers. (shrink)

Telic sufficientarians hold that there is something special about a certain threshold level such that benefiting people below it, or raising them above it, makes an outcome better in at least one respect. The article investigates what fundamental value might ground that view. The aim is to demonstrate that sufficientarianism, at least on this telic version, is groundless and as such indefensible. The argument is advanced in three steps: first, it is shown that sufficientarianism cannot be grounded in a personal (...) value. Neither, secondly, is it committed to the person-affecting view, the view that says that nothing can be better if there is no one for whom it is better. This, in itself, is of interest because some sufficientarians reject egalitarianism precisely for its alleged incompatibility with the person-affecting view. Sufficientarians' disavowal of the person-affecting view implies that their view, similarly to egalitarianism, must be anchored in some impersonal value. But crucially, and this is the third step of the argument, there is no apparent value that can fit that role. We must conclude, then, that telic sufficientarianism is groundless. (shrink)

Can outcome equality (say, in welfare) ever be unjust? Despite the extensive inquiry into the nature of luck egalitarianism in recent years, this question is curiously under-explored. Leading luck egalitarians pay little attention to the issue of unjust equalities, and when they do, they appear not to speak in one voice. To facilitate the inquiry into the potential injustice of equalities, the paper introduces two rival interpretations of egalitarianism: the responsibility view, which may condemn equalities as unjust (when they reflect (...) unequal levels of personal responsibility); and, the non-responsibility view, which does not. It then teases out the implications of these two views, in the hope of establishing that the latter is at least as plausible as the former. The paper thus establishes that the egalitarian ideal can be plausibly formulated in a way that condemns only (certain) inequalities but never equalities, and that this formulation is both coherent and attractive. (shrink)

In recent work, Norman Daniels extends the application of Rawls's principle of ‘fair equality of opportunity’ from health care to health proper. Crucial to that account is the view that health care, and now also health, is special. Daniels also claims that a rival theory of distributive justice, namely luck egalitarianism (or ‘equal opportunity for welfare’), cannot provide an adequate account of justice in health and health care. He argues that the application of that theory to health policy would result (...) in an account that is, in a sense, too narrow, for it denies treatment to imprudent patients (e.g. lung cancer patients who smoked). In a different sense, Daniels argues, luck egalitarian health policy would be too wide: it arguably tells us to treat individuals for such brute-luck conditions as shyness, stupidity, ugliness, and having the ‘wrong’ skin colour. I seek to advance three claims in response to Daniels's revised theory, and in defence of a luck egalitarian view of health policy. First, I question Daniels's assertion regarding the specialness of health. While he is right to abandon his insistence on the specialness of health care, it is doubtful that health proper can be depicted as special. Second, I try and meet Daniels's objections to luck egalitarianism. Luck egalitarian health policy escapes being too narrow for it does not in fact require denying basic care to imprudent patients. As for it being allegedly too wide, I try to show that it is not, after all, counterintuitive to rid individuals of unfortunate and disadvantageous biological traits (say, a disadvantageous skin colour). And third, I question whether Daniels's own Rawlsian account is in fact wide enough. I argue that fair equality of opportunity fails to justify some standard medical procedures that many health systems do already practice. (shrink)

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

:The paper seeks to defend Telic Egalitarianism by distinguishing two distinct categories into which typical objections to it fall. According to one category of objections TE isgroundless. That is, there is simply no good reason to think that inequality as such is bad. The other type of objections to TE focuses on itscounterintuitiveimplications: it is forced to condemn inequalities between ourselves and long-dead Inca peasants, or between us and worse-off aliens from other planets. The paper shows that once we unpack (...) these two types of objections to TE they become much less persuasive. (shrink)

In a recent article, Michael Otsuka and Alex Voorhoeve argue that prioritarianism fails to account for the shift in moral significance in gains to individuals in interpersonal as compared to intrapersonal cases. In this article, I show that the priority view escapes this objection but in a way that deprives it of its anti-egalitarian stance. Despite Otsuka and Voorhoeve, prioritarianism, rightly understood, provides consistent and attractive recommendations in both single- and multi-person cases. Yet prioritarians, the article goes on to show, (...) cannot do so while availing themselves of the leveling down objection to egalitarianism. They may not do so because similarly to egalitarianism, prioritarianism also must reject the principle of personal good. That is, egalitarians and prioritarians may sometime recommend certain actions and outcomes even when these are better for no one. Prioritarians may survive the Otsuka–Voorhoeve critique, but to do so they must abandon their anti-egalitarian stance. (shrink)

The paper examines the view that individuals have a claim to the jobs for which they are the best qualified. It seeks to show this view to be groundless, and to offer, instead, a luck egalitarian account of justice in hiring. That account consists of three components: monism, non-meritocracy, and non-discrimination. To demonstrate the coherence of this view, two particular internal conflicts are addressed. First, luck egalitarian monism (the view that jobs are not special) may end up violating the non-discrimination (...) requirement. Second, non-discrimination, it is often suggested, cannot be defined without reference to qualifications, thus violating the non-meritocracy requirement. The paper seeks to address these, as well as other, potential objections, and show that whereas meritocratic accounts are without basis, luck egalitarianism provides a coherent and attractive account of justice in hiring. (shrink)

Stuart White and others claim that providing welfare benefits to citizens who do not, and are not willing to, work breaches the principle of reciprocity. This, they argue, justifies placing a minimum work requirement on welfare recipients. This article seeks to rebut their claim. It begins by rejecting the attempt to ground the work requirement on a civic obligation to work. The article then explores the principle of reciprocity, and argues that the practice of reciprocity depends on the particular conception (...) of distributive justice adopted. An examination of different interpretations of egalitarian justice and their corresponding patterns of reciprocity demonstrates that unconditional welfare benefits are compatible with, and sometimes even warranted by, the principle of reciprocity. Thus, imposing a work requirement on welfare recipients is by no means a mandate of reciprocity. Key Words: contractualism • unconditional basic income • reciprocity • welfare state • work. (shrink)

Utilitarians are said to be indifferent between interpersonal and intrapersonal transfers. In doing so, they fail to register the separateness of persons. This ‘separateness of persons’ objection has been traditionally used against utilitarianism, but more recently against prioritarianism. In this paper, I examine how yet another distributive view, namely sufficientarianism, fares in this respect. Sufficientarians famously believe that while inequality as such does not matter, what does matter is that all individuals meet some adequate threshold. It is often taken for (...) granted that sufficientarianism does not violate the separateness of persons. In this paper, I seek to show that that is not the case. The main challenge, however, proves to be formulating an accurate understanding of what the separateness of persons precisely means. I offer several interpretations and argue that sufficientarianism, surprisingly, violates them all. Sufficientarianism, just like utilitarianism does not respect the separateness of persons. (shrink)

Luck egalitarians typically hold that it is bad for some to be worse off than others through no fault or choice of their own. In this paper I want to address two complaints against standard luck egalitarianism that do not question responsibility-sensitivity. The first objection says that equality itself lacks inherent non-instrumental value, and so the luckist component ought to be attached to a different pattern, say prioritarianism. The second objection also endorses luckism but worries that luck egalitarianism as conventionally (...) formulated is committed in fact to neutralizing not just brute luck but also option luck. And this would mean, among other things, compensating unsuccessful gamblers, which is something many egalitarians find counterintuitive. My aim is to show that there is a way for luck egalitarianism to meet both criticisms; that it can maintain its egalitarian credentials while avoiding the counterintuitive consequences of compensating unsuccessful gamblers. To do so, I propose, we ought to understand luck egalitarianism as resting on the disvalue of being arbitrarily worse off compared to others. In addition, I suggest, the badness of luck egalitarian inequality – that of arbitrary disadvantage – has both an inter-personal and an intra-personal dimension. (shrink)

Individuals come into the world with talents that differ greatly in their marketability. These talents command a wide variety of rents; from millions of dollars per film for a movie star, to just a few thousands of dollars per annum for a fast-food joint worker. How should we distribute income fairly given these disparities? That is the topic of Kristi Olson’s excellent new book, The Solidarity Solution: Principles for a Fair Income Distribution. 1 1 The question is not new, but (...) Olson’s treatment is among the most comprehensive and well-argued one can find. The manuscript is well researched, scholarly, thorough, packed full of arguments and low on fluff. It is well worth the time of anyone interested in fairness in the sphere of work and income. (shrink)

The article assesses recent attempts to deflect two persistent objections to Positive Egalitarianism (PE), the view that equality adds to the goodness of a state of affairs. The first says that PE entails bringing into existence individuals who are equal to each other in leading horrible lives, such that they are worthnotliving. I assess three strategies for deflecting this objection: offering a restricted version of PE; biting the bullet; and pressing alevelling outcounter-objection. The second objection points out that for any (...) world A containing many individuals all leading very satisfying lives, and in perfect equality, PE prefers a much larger, perfectly equal population Z with much lower (yet positive) well-being. I review two main strategies for avoiding this Repellent Conclusion: a Capped Model and making egalitarianism sensitive to welfare levels. Both solutions, I show, are worse than the problems they are meant to solve. (shrink)

La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de salud. Por lo (...) tanto, el informe es pertinente para cada agente que infl uye en ese camino y en particular para los gobiernos, ya que se encargan de supervisar y guiar el progreso hacia la cobertura universal de salud. (shrink)

According to the Competing Claims View we decide between alternatives by looking at the competing claims held by affected individuals. The strength of these claims is a function of two features: how much they stand to benefit by each alternative, and how badly off they would be in its absence. The view can be, and is, endorsed by both egalitarians and prioritarians. For the former the second condition will concern looking at how badly off the person is relative to others, (...) whereas for the latter it will be how badly off she is in absolute terms. In this paper I want to argue that neither should be endorsed. The egalitarian version of CCV breaks down when attempting to assess the competing claims of possible persons who may never exist. Also, the view, on at least one plausible interpretation, leads to intransitive judgements. The prioritarian version of CCV, in turn, is vulnerable to its own unique objection, namely delivering an anti-prioritarian and rather implausible verdict in certain Single Person Cases. (shrink)

This report from the WHO Consultative Group on Equity and Universal Health Coverage offers advice on how to make progress fairly towards universal health coverage.

Some egalitarians argue against public services that are free for all, on the grounds that free access appears to primarily benefit the middle classes. I advocate, instead, the inclusion of the middle classes in public services, arguing that only truly universal intake of public services prevents the inegalitarian effects of economic segregation. Such universal participation in public services is achieved, partly, through subsidies for, and regulation of, privately produced services.

Philippe Van Parijs suggests that in culturally divided societies health care systems (and perhaps other welfare services) should be divided along regional lines. He argues that since members of homogenous societies have relatively similar needs and tastes, it is easier for them to agree on a rather comprehensive distributive scheme. This proposed reform of health care, Van Parijs argues, would be consistent with distributive justice rather than undermine it. Against Van Parijs, the paper demonstrates that this policy of devolution upsets (...) distributive justice. Devolution does so by shifting the pattern of distribution (across communities) from distribution according to need, to distribution of equal shares. The paper also argues that devolution is likely to weaken solidarity across the polity as a whole, which further undermines the attainment of distributive justice. The paper concludes that far from catering to culturally driven differences in medical preferences, distributive justice (in fact) permits disregard of such differences, and warrants enforcing a unitary pattern of consumption of medical goods (and other welfare services) across the citizenry, thus retaining a unified health care (and correspondingly, welfare) system. Key Words: devolution • health care • justice • solidarity • Van Parijs. (shrink)