In this essay I will analyze Kai Nielsen’s arguments from his essay “Autonomy, Equality and the Health Care System” that 1) a just society, such as that in the United States, is also a roughly equal society, and further 2) a just society would have a single-payer, one tiered health care system. First, I will reconstruct Nielsen’s argument, and then I will critically evaluate his presented arguments.
First, Nielsen states that autonomous social policies do not conflict with egalitarian policies. Further, Nielsen argues that autonomy requires egalitarianism, which is a social philosophy that advocates social equality. A reconstruction of his argument would go thusly:
1. A just society is committed to moral equality.
2. Moral equality requires equality of condition.
3. Just societies are committed to and respect the autonomy of their citizens.
C1: Equality of condition requires equal autonomy.
C2: An autonomous society is also an egalitarian society.
Nielsen states ”I shall argue…that autonomy cannot be widespread or secure in a society which is not egalitarian: where, that is, equality is not also a fundamental value which has an operative role within the society” (Munson 708). This is to mean, as reconstructed above, that for a society to be autonomous (in that its citizens are “capable of self-direction” (708)) it must also be egalitarian. The first premise of Nielsen’s argument relies on the idea of “moral equality,” which is to mean, as Nielsen says, “the life of everyone matters and matters equally“ (708). From this definition, I propose that the first premise is a self-evident claim.
Nielsen later states, “Liberty cannot flourish without something approaching this equality of condition, and people without autonomous lives will surely live impoverished lives….In fine, a commitment to achieving equality of condition, far from undermining liberty and autonomy, is essential for their extensive flourishing” (708). Nielsen proposes that it is...