What is the value of health? It may seem odd to even raise this question. Yet the truth is that we put a price on health all the time: the average annual cost of insulin for an individual (about $6,000), the annual cost of HIV antiretroviral therapy (average price over $36,000), and the cost of a kidney transplant (average price about $442,500).
There is a whole field of study, largely under the umbrella of decision science, that works to quantify everything from the price of different health interventions to human life itself. Such work helps inform decision-making in a range of sectors, including business, law, public health, and regulatory work at the federal level. Throughout the history of government regulation, federal agencies have tried to put a dollar value on a single life for the purposes of weighing the tradeoffs involved in adopting new regulations. Core to such tradeoffs is being able to weigh the cost of a given approach within a finite resource pool, which then necessitates placing a dollar value on a life. According to various calculations made at various times and by various agencies since the 1970s, a single life has been valued at $885,000, $1 million, $2.5 million, $7.4 million, $8.7 million, and $9.6 million.
There is a paradox at the heart of this that is worth acknowledging, in which the price we put on health is often far too high and, at the same time, not high enough. It is too high in that expensive treatments can put quality healthcare out of reach for many. It is not high enough because most people would likely agree that even the most astronomical sum falls short of the true worth of a human life.
What does our effort to grapple with value in the context of health mean for our pursuit of health at the population level? My interest in how we value health and the costs we are willing to incur to support it comes principally from three observations. First is the tried-and-true aphorism, perhaps the fundamental truth for all ahead of us in life’s journey, that all that matters is good health. This suggests that health may indeed be priceless, setting up an ideal that runs into challenges when it meets the cost-benefit analysis that inevitably characterizes our real-world engagement with health. Health may be priceless, but resources are finite, so we cannot avoid thinking about costs in the context of health.
This suggests the question: Does health indeed have a price? If so, who sets it? What does this mean for thinking about health? And should we really pursue health at any cost, including at the expense of living the kind of life health enables?
Before we can answer these questions, we must return, once again, to what we mean by “health.” What we mean by health determines what we are willing to do for health, whether we are willing to advance health at all costs. In these essays, I have often argued that “health” should be a means to an end, and that end is the ability to live a rich, full life in a context of dignity and opportunity for everyone. This means that we should take no action in pursuit of health that undermines what health is fundamentally for. We should be willing to spend much on whatever supports the living of a fully realized, healthy life. This includes spending on everything from wheelchair ramps and accessible reading materials for students to things like safe exercise opportunities in all neighborhoods so that kids who are gifted at sports are discovered early and can achieve their full potential.
It may seem that such spending is incidental to health and that “real” health spending is our investment in the drugs and treatments that help extend life. But what is life if it is without what makes it most meaningful? Education, the opportunity to discover and develop talents, the chance to enjoy nature, and having the time to build and maintain connections with family and friends—this is the stuff of a healthy life, and nothing is more worthy of investment. If we are willing to spend vast sums on defense, on keeping afloat corporations that are “too big to fail,” and on other national priorities, we should be willing to spend just as much on the social and material resources that support a healthy life. This means shaping a public conversation where health is understood as more than simply the treating of disease and the prolonging of life. Health is the full range of social networks, material goods, and human experiences that make life meaningful and worth living.
So, the argument is not about whether we are willing to achieve health at all costs but whether we are willing to build a society that allows us all to live a life with dignity, that maximizes opportunity at all costs, that supports time with friends, colleagues, and loved ones. What does it mean to embrace such a vision? What would it cost?
Principally, it means that investment in health becomes largely a matter of social ventures, which is a question of priorities. It is, in some ways, simpler to invest in health by way of healthcare alone. Doing so means mostly confining investment to a single sector—healthcare.
When we invest in health, rather than just healthcare, we are faced with a more complex task. We then must evaluate the costs and benefits across a range of sectors, from education to urban development to agriculture to shoring up the social safety net. This process of evaluation means we must indeed weigh the costs of certain interventions against others, always looking to maximize our investment. But this does not mean we should accept an ever-greater expenditure on healthcare at the expense of the forces that shape health.
We currently spend about $4 trillion annually to optimize what we call health, but this investment largely goes to healthcare. How much healthier would our world be if we spent that much on the social and physical environment that allows us to live richly realized lives? What if we invested trillions each year in measures like tackling economic inequality, addressing systemic racism, building healthier urban spaces, and subsidizing nutritious foods? A world supported by such investment would be worth paying a high price for indeed.
A version of this piece also appears in Substack.
Can We Put a Price on Health?
24
0
28.11.2023
What is the value of health? It may seem odd to even raise this question. Yet the truth is that we put a price on health all the time: the average annual cost of insulin for an individual (about $6,000), the annual cost of HIV antiretroviral therapy (average price over $36,000), and the cost of a kidney transplant (average price about $442,500).
There is a whole field of study, largely under the umbrella of decision science, that works to quantify everything from the price of different health interventions to human life itself. Such work helps inform decision-making in a range of sectors, including business, law, public health, and regulatory work at the federal level. Throughout the history of government regulation, federal agencies have tried to put a dollar value on a single life for the purposes of weighing the tradeoffs involved in adopting new regulations. Core to such tradeoffs is being able to weigh the cost of a given approach within a finite resource pool, which then necessitates placing a dollar value on a life. According to various calculations made at various times and by various agencies since the 1970s, a single life has been valued at $885,000, $1 million, $2.5 million, $7.4 million, $8.7 million, and $9.6 million.
There is a paradox at the heart of this that is worth acknowledging, in which the price we put on health is often far too high and, at the same time, not high enough. It is too high in that expensive treatments can put quality healthcare out of reach for........
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