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.

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关于卫生保健平等的一些评论

人口中健康的单变量分布对平等主义者而言是无关紧要的，无论是关系的还是分布的，关系平等的人都很难说出健康的分布如何影响个人是否能够平等互动。两种均等主义者都对健康和与幸福相关的其他因素之间的相关性感兴趣，尽管关系均等主义者与分配均等主义者不同，对分配没有最终兴趣。很难确定卫生保健的分布或关系平均主义理想分布，并且很难确定哪种政策可以最好地实现这些理想。平等主义者对健康特别感兴趣的主要是健康与其他相关社会因素与卫生保健分布之间的联系，公共卫生计划和健康研究。可以认为，应该以最具成本效益的方式重新分配卫生保健资源，而不是仅仅通过对总福利的影响来衡量有效性，而是通过对某种平等价值的衡量结果来衡量有效性。但是，从伦理上对使用成本效益信息来分配医疗资源存在反对意见，即使对“有效性”有平等的理解。很难在与卫生保健预算分配有关的道德考虑中做出选择：在平等目标方面的效率，优先治疗那些健康问题最严重的人，为所有人提供公平的机会以及避免歧视是困难的问题。监管市场为应对这些困难提供了一种可能的应对措施。