Ronald Dworkin’s “Prudent Insurance” Ideal for Healthcare: Idealisations of Circumstance, Prudence and Self-interest

Abstract

I will focus on Dworkin’s use of idealisation in his “Prudent Insurance” Ideal for healthcare. Dworkin identifies problems with the circumstances under which people make their insurance decisions in the current United States healthcare system and he sees these as being the cause of strange resource allocation outcomes. He therefore imagines idealising away these prima facie unjust circumstances to develop a hypothetical market in which people are able to make better decisions (Section “Idealisation of Circumstance”). I will identify two further idealisations that Dworkin relies on in his theory. The first is to idealise people to be perfectly prudent (Section “Idealisation of Prudence”), which I consider to be justifiable, but difficult to actually apply in practise. The second is to idealise people to be perfectly self-interested (Section “Idealisation to Self-interest”). I do not see this as a justifiable idealization since it ignores principles of altruism and citizenship, which would seem to be deeply relevant to a theory of justice.