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Should health be considered a social good in its own right, or can it be treated as a commodity, and if so, to what extent? This text discusses the type of answers that can be given to these questions, based on Michael Walzer’s notion of “spheres of justice”. It returns to the type of approach to distributive justice in health and healthcare deriving from Walzer’s theory: it sheds light on the type of critique of the liberal healthcare system to which the spheres theory leads, as well as the type of critical view that it is possible to take of inequalities from a Walzerian perspective. The text also seeks to clarify the value of sphere pluralism, exploring two possible interpretations: that of pure pluralism, which makes it possible to problematise issues associated with the medicalisation of the social, and that of mitigated pluralism, which seems better suited to grasping health as a “mixed” good. While we feel that this mixed pluralism approach is more fruitful, we would stress that it should seek a satisfactory balance between the two poles of local autonomy and complex equality: from this angle, mixed pluralism does not necessarily imply abandoning spheres as a problem, whose critical function we emphasise (particularly when it comes to critically analyzing the place of market mechanisms in healthcare systems).