This article, based on ethnographic work in rural Tamil Nadu, explores the relative invisibility of class and its characteristic modes of operation in the literature on medical pluralism in India. Using, as key concepts, habit, comfort, pre-familiarity and familiarization, the article suggests that we can shift the way we think of 'pragmatism', the term that is routinely used to describe subjects who follow pluralist strategies. In reconceptualizing pragmatism, we can allow ourselves to glimpse anew the workings of class within pluralist strategies. The article takes inspiration from Gramsci's critique of the self-evidence of 'common sense', as well as from the phenomenological aspects of Bourdieu's understanding of class and habitus. It explores the very different levels of comfort and authorization that different classes display in relation to biomedical spaces and practices, as well as towards non-biomedical discursive practices.