Some Remarks on Equality in Health and Health Care

The univariate distribution of health in a population is of little interest to egalitarians, whether relational or distributional, and the relational egalitarian has a hard time saying anything about how the distribution of health bears on whether individuals can interact as equals. The correlations between health and other factors relevant to well-being are of interest to both kinds of egalitarians, even though the relational egalitarian, unlike the distributional egalitarian, has no ultimate interest in distribution. It is difficult to specify distributional or relational egalitarian ideal distributions of health care and to determine what policies would best implement these ideals. What is of particular interest about health to egalitarians are mainly the links between health and other relevant social factors and the distribution of health care, public health programs, and health research. It might be thought that health care resources should be redistributed in the most cost-effective way, measuring effectiveness not by the consequences for total welfare alone, but by the consequences for some measure of egalitarian value. But there are ethical objections to the use of cost-effectiveness information to allocate health-care resources, even with an egalitarian understanding of “effectiveness.” It is very difficult to adjudicate among the moral considerations that are relevant to the allocation of the health-care budget: efficiency with respect to egalitarian objectives, prioritizing the treatment of those whose health problems are worst, offering fair chances to all, and avoiding discrimination are difficult problems. Regulated markets offer one possible response to these difficulties.