In his influential essay on equality, Bernard Williams argues that the only proper criterion for the distribution of medical care is medical need. Calling this category ‘equality of need’ – as opposed to ‘equality of merit’ – Williams contends that as far as need is concerned, the only rational system of distribution is one based on people’s actual need for the good in question. Any other criterion, such as wealth, would be irrational and lead to inequality.
However, in his own counter-argument, Robert Nozick suggests that Williams has misunderstood the concept of ‘equality’. This essay will consider the nature of Nozick’s criticisms and whether they are valid arguments in the light of what Williams proposed. I will conclude by suggesting that Nozick has incorrectly interpreted Williams.
Starting then at William’s original argument, whenever we have the situation of having to distribute a scarce resource among society, we will always be faced with questions of equality. Who deserves access to the resources? In the case of medical care, every single person who desires treatment might not necessarily have the ability to obtain the resources. In some societies, wealth might become the dominant factor, with the rich ill receiving preferential treatment over the poor ill. However, Williams asserts that such a distribution would be irrational. Rather, we need to distribute resources based on whoever truly needs the goods in question. In the case of medical need, only ill members of society require the resources. Other types of resources, such as education, are based more on ‘equality of merit’, so these resources can be dealt with separately from actual need.
To support Williams’s argument, you could contend that ill people have very little choice but to obtain medical treatment. If they lack the wealth, they are hardly in a position to go out and secure a job in order to save up enough money. Furthermore, it is also in society’s interest to have a community of healthy individuals, as such people are more able to contribute to society in the future. Finally you may also have a case of an infectious disease, in which case it is definitely in society’s interest to provide the medical treatment. Williams is correct to assert that medical care should be distributed on medical need alone.
Robert Nozick however provides an opposing view, arguing that the medical profession is under no such obligation to provide treatment to those who actually need it. The main thrust of Nozick’s argument is as follows. Society sets up a ‘pattern of distribution’, which sees its resources distributed throughout the members of the society in a legal and just way. A taxation system or a welfare system are two examples of a pattern of distribution. Nozick is not concerned exactly what that pattern is, rather the fact that it exists in the first place. Any resources that people obtain legally from the distribution can then be legally used in whatever way the person desires. Society cannot control people in how they decide to use the resources justly distributed to them.
So using the example of a barber, Nozick argues that society has equipped that barber with the resources for carrying on his profession, so he can distribute his services to whoever he desires. It would be ridiculous to contend that ‘barbering need’ was the main priority. The barber has a certain skill, and he is able to charge whatever he wants to perform a service. This would be no different to a champion basketball player receiving any extra payment just so people can watch him play. In all cases, the pattern of distribution is fair and equitable, which means any subsequent use of the resource is also fair and equitable.
However, Nozick may not have interpreted Williams correctly here. Williams was specifically arguing for ‘equality of need’, which includes those cases of absolute necessity for the good in question. Barbering ‘need’ – or gardening need or any other category mentioned by Williams – does not have the same sense of necessity. No fundamental rights come under challenge by people deciding to go to the barber or not. This is not the case with medicine, which often deals with life and death scenarios. Williams may agree that as far as a barber is concerned, the barber is fully entitled to charge whatever he or she wants.
Williams provides no arguments to suggest that general commercial exchanges should be restricted. This is a fundamental point for Nozick. Society – even a strictly socialist society – can do nothing to restrict private dealings between members of the society. Williams however does nothing to dispute this. He is merely saying in certain cases (‘equality of need’) society needs to be mindful in setting up an equitable system of distribution.
To conclude, Williams provides a strong argument in favour of distributing certain key resources based on need alone. Medical care is one example of this. Nozick contends that ‘need’ is an insufficient basis for a free society to be distributing its resources, and all that matters is that the resources were obtained justly under a pattern of distribution. However, Nozick fails to recognise that medical need is a special case. As indicated above, it is in society’s interests as a whole to provide treatment. Therefore, Nozick’s arguments cannot be considered persuasive in regards to all the scarce resources of society.