 The social bases of health deserve this priority, Fishman and MacKay (2019: 615) suggest, since health is necessary if people are to realize their highest order interests in developing and exercising their two moral powers. Inequalities in the distribution of the social bases of health, and so inequalities in health status resulting from such a distribution, are just if the least advantaged on the social health gradient have a higher expected health status than they would under an equal distribution (Fishman &amp; MacKay 2019: 616). Kniess (2019: 418), by contrast, argues that the social bases of health should be governed by the difference principle, though he concedes that this complicates the indexing problem, namely, that there is no obvious way to rank different distributions of income and wealth, the powers and prerogatives of offices and positions of responsibility, and the social bases of health. Kniess (2019: 420) concludes that such tradeoffs must be decided through the democratic process. While Fishman and MacKay (2019) avoid this problem by prioritizing the social bases of health, as Kniess argues (2019: 418–420), his approach may be preferable since it permits tradeoffs between health and income and also leaves more room for political communities to set priorities.