This chapter deals with the topic of inequality in the healthcare sector. The chapter begins by looking at some summary data and the inequality in various measures of health that are obvious from simple differences. Then the chapter discusses some basic social philosophy on the topic of how to judge fairness in an abstract society. More detailed data on health outcomes is then explored, highlighted inequality along different demographic lines. Then there is a discussion of theories that fit the facts presented: why do these inequalities exist, and what do we learn by unpacking them: both social implications as well as clinical. Finally, inequalities in the labor market for healthcare workers are discussed.

The final chapter examines Cavell’s theory of democratic perfectionism. Traditional perfectionist political philosophy views the purpose of the polity as the promotion of human flourishing. Contemporary liberals rejected perfectionism on two grounds. John Rawls believed perfectionism was antidemocratic because it was elitist. Isaiah Berlin claimed perfectionism was illiberal because it posited a singular end to life at the expense of all others. Against these claims, Cavell’s later work recovered an inherently egalitarian variety of perfectionism from the American Transcendentalist tradition. While agreeing with Cavell’s defense of perfectionism against liberal critiques, the chapter raises two limits to perfectionism. The first is that it runs the risk of turning into “debased perfectionism,” where striving for an unattained yet attainable self can lead to status anxiety. Second, Cavell pays insufficient attention to the economic conditions necessary for one to lead a perfectionist life. The chapter concludes by reading Thoreau’s writings on economics against Cavell’s reading of Thoreau. It argues that a greater attention to the economic dimension in perfectionism would address some of the concerns that liberal critics raise about perfectionism elitism.

Political philosophy is shaped by an understanding of the circumstances of justice, which describe the need for justice. This chapter argues that the circumstances of justice should be understood to include contingent facts about the history of the society to be governed, ideally, by principles of justice. In locating structures of domination within the circumstances of justice that motivate the theoretical task, I depart from the approach taken by John Rawls. Though I will not dispute the content of Rawls’s favored principles of justice, I show that when we revise the description of the circumstances of justice, we revise our understanding of the importance of those principles. We can thus add something to what Rawls has to say about the good of justice. One aspect of the good of distributive justice is that it provides a basis for moral repair in the wake of collective wrongdoing.

This chapter offers a reassessment of two familiar lines of criticism against Rawls’s Original Position (OP): the idealization critique and the fact-sensitivity critique. The former holds that the OP is too detached from the real world to deliver the right principles for us. The latter holds that the OP concedes too much to empirical reality for the resulting principles to tell us what “true justice” requires. I argue that we can blunt the force of these critiques once we fully appreciate the role that the OP plays in Rawls’s work. I distinguish between (i) Rawls’s theory, (ii) the arguments offered in support of it, and (iii) the desiderata applying to that theory, given its function. I then show that the idealization critique partly misfires, since the idealizations Rawls appeals to operate at the level of the argument offered in support of his theory, not at the level of the theory itself. Similarly, we can see that the fact-sensitivity critique does little damage to Rawls’s theory, once the theory’s function, hence the desiderata applying to it, are fully appreciated.

Critics of Rawls’s principles of justice complain that they ignore considerations of merit or desert. As meritocracy is the chief justification for the extremely wide inequalities between workers at the top and bottom today, we need to examine this complaint. I argue that ideas of desert or merit are inherently unsuited to informing principles of justice for the basic structure of society. Moreover, attempts to raise the principle of desert to the systemic level have historically formed the ideological grounds for irresolvable class warfare. Rawls’s principles of justice supply a normative perspective that wisely aims to transcend class warfare. Rawls’s conception of property-owning democracy, culturally shaped by public affirmation of the difference principle, offers a plausible vision of how society may achieve such transcendence.

This chapter examines John Rawls’s uncritical acceptance of “sound” finance, how it reflects his use of his constructive method, his influences in neo-classical economics, and the regrettable consequences. It also suggests how we can unlearn deference to neo-classical thinking, using Rawls’s method, in view of Abba Lerner’s functional finance and an egalitarian form of central banking.

Rawls introduces the idea of a well-ordered liberal society in the 1996 introduction to Political Liberalism. A liberal society is well-ordered when governed by one or another reasonable liberal political conception. Rawls says: “political liberalism is to be understood as a freestanding family of reasonable liberal political conceptions.” I discuss the main features of reasonable liberal conceptions within well-ordered liberal societies, and the centrality of the criterion of reciprocity. Liberal conceptions are not reasonable if they fail to impose any formal restrictions on permissible inequalities or fail to limit the effects of wealth on democratic politics. This includes not only libertarianism but also a wide range of classical and neo-liberal positions. None of these are reasonable according to Rawls’s criterion of reciprocity, and none satisfy his liberal principle of political legitimacy, since all permit and even encourage unrestricted inequalities and individuals’ unlimited accumulation of wealth and economic powers.

The precept, “One person, one vote,” is an article of faith in contemporary democracies. Nevertheless, many theorists and philosophers—historically, John Stuart Mill, and recently. others—have advocated unequal suffrage in order to favor the input of those who would vote more wisely. Strikingly, in A Theory of Justice John Rawls says that Mill’s argument for such epistemically motivated plural voting is, “of the right form,” adding that, “plural voting may be perfectly just.” I will argue that this is deeply rooted in Rawls’s theory, not a mere curiosity. Rawls subordinates political equality to other basic liberties and his case for doing so is carefully considered. I go on to ask, inconclusively, what might be a good reply that is responsive to Rawls’s concerns – a strong case for a more absolute commitment to equal suffrage.

Rawls’s Original Position, the most influential thought experiment in modern political philosophy, cannot be the justification of Rawls’s theory of justice as fairness. The Original Position cannot satisfy Rawls’s own publicity condition, which requires justifications that are accessible to all citizens. I hypothesize that over time Rawls weakened his publicity condition because he saw this tension, but that he could not resolve it. However, Rawls’s work contains a justification for justice as fairness that is publicly accessible: that in a well-ordered society, all citizens can have self-respect. I set up this discussion with Rawls’s critique of meritocracy, which, Rawls fears, sets citizens against each other in a zero-sum competition for self-respect. In a meritocracy, elites display their power and wealth, while the less fortunate may fall into resentment, rancor, and possibly a destructive racial nationalism. A Rawlsian society of self-respect offers a more just and stable model of social unity.

Rawls’s argument that a well-ordered society would be a social union of social unions is crucial to his larger argument for stability. The former argument depends upon what I call “the security assumption.” I contend that reasonable religious pluralism casts doubt on the assumption and on the argument which appeals to it. Seeing why the dubitability of the security assumption makes the idea of a social union of social unions non-viable, we can come to a better understanding of the development of Rawls’s thought. Equally if not more important is the relevance of the security assumption for contemporary politics. That assumption identifies a condition that must be satisfied if members of a liberal democracy are to find their collective activity as citizens inherently valuable. Failure to satisfy that condition suggests why some members of liberal democracies as we know them deny the inherent value of relations with their fellow citizens.

In his work of 1844, Marx claims that human beings realize their nature through the joint activity of labor in a true communist society. In A Theory of Justice, Rawls calls the joint maintenance of a just society “the preeminent form of human flourishing. He says that “persons best express their nature” by maintaining just institutions. For both writers, what makes these joint activities central to the human good is the relationships they maintain among individuals who do not know of one another’s existence, relationships among distant unknowns. A necessary condition for these relationships to obtain is, in each case, a particular social ethos. If a standard left-wing critique of the market is cogent, and if the well-ordered society of Theory involves a widespread market, then the several elements in the desired social ethos of justice as fairness might be in tension with one another, might not be capable of being satisfied simultaneously. Rawls’s desired relationships might not obtain.

This chapter synthesizes the unifying theme across the different domains by mapping each conflict onto the egalitarian–libertarian debate: does autonomous constituent self-rule demand ensuring that all constituents enjoy a baseline substantive opportunity to contribute to public governance, or require noninterference with the application of private power and constituent preferences (including by powerful or privileged constituents who will enjoy disproportionate practical influence over politics)? The Conclusion also describes the two related trends in current Supreme Court lawmaking that threaten contestation over freedom. There is the threat – most clearly expressed in Bush v. Gore – that purely tribal partisanship will overdetermine election law outcomes and displace rather than frame the debate over freedom. Second, the parallel rise of the use of summary modes of disposition further erodes the opportunities for philosophical engagement by the bench.