 Second, the specific assumptions in (3) are very strong and arguably cannot be realized. The argument that presupposes them should thus be seen as an analytic tool and not an attempt to say anything very specific about how real institutions could be designed. (We note that this strong requirement is not needed by the model of universal and equal access that emphasizes real choice. Instead, the choice model allows for income inequalities and only needs subsidies to equalize the affordability of buying insurance equal in scope to what the ACA requires of insurance purchased on the exchanges it authorizes.) Without, for example, knowing what level of resources would result from equalizing resources, we can say little about what levels of insurance coverage for specific conditions are welfare enhancing for individuals. Since there is no feasible way to meet the assumptions about the distribution of medical knowledge or the exclusion of knowledge of individual risks, these assumptions make Dworkin’s argument completely hypothetical and theoretical rather than practical. Third, the assumption that there is an ideally competitive insurance market postulated in the fourth step of the argument adds to the hypothetical nature of the argument as a whole.