1. I paraphrase Charles Fried, Right and Wrong (Cambridge, Mass.: Harvard University Press, 1978), pp. 126ff. See my comments on Frieds proposal in “Rights to Health Care: Programmatic Worries,” Journal of Medicine and Philosophy, IV (June, 1979), 174–91. I ignore here an issue of paternalism that Fried may have wanted to pursue but which is better raised when fair shares are clearly large enough to purchase a reasonable insurance package. Should the premium be compulsory?
2. Arrow’s classic paper traces the anomalies of the medical market to the uncertainties in it. My analysis has a bearing on the further moral issue of whether health care ought to be marketed in an ideal market. Cf. Kenneth Arrow, “Uncertainty and the Welfare Economics of Medical Care,” American Economic Review, LIII (1963), 941–73.
3. The presence of people with preferences for more-than-reasonable coverage may result in inflationary pressures on the premium for “reasonable” insurance packages. Therefore interference in the market is likely to be necessary to protect the adequacy of fair shares.
4. For emphasis, we often refer to things we simply desire or want as things we need. Sometimes we invoke a distinction between noun and verb uses of the word need so that not everything we say we need counts as a need. Any distinction we might draw between noun and verb uses depends on our purposes and the context and would still have to be explained by the kind of analysis I undertake above.
5. T. M. Scanlon, “Preference and Urgency,” Journal of Philosophy, LXXVII (November, 1975), 655–69.