Across the world, governments are going to incredible lengths to save lives and health from the coronavirus. Those incredible lengths often have an incredible price tag attached, but one that isn’t easy to calculate.
However, calculating health care costs has long been a key aspect in formulating policy – this is what health economists do. Sometimes vilified as constituting “death panels,” these people are charged with assessing the relative value of one drug over another, one procedure over another, and potentially also with the battle against one disease over the battle with another.
Except they’re not.
Strangely, when it comes to coronavirus, the debate about “how much should we be willing to pay for this” is absent. It’s even more strange when we consider the tremendous costs that have swamped entire economies and sent millions into unemployment – with seemingly no end in sight.
In the United Kingdom, the government has an entire apparatus for making calculations which basically boil down to whom to save, and whom to sacrifice. Dubbed “NICE” (though it isn’t – it’s simply necessary), those initials stand for the “National Institute for Health and Care Excellence” and its members include both experts and people recruited from the general public, though it’s not clear exactly how they are recruited. What matters is that there is at least an impression that the views of the man on the street are taken into account during the regular debates on which drugs are subsidized by the government and make it into the NHS basket.
NICE takes into account “life years saved” and usually approves measures where the cost per life year saved is less than £30,000 ($38,750). This makes it easy to compare between treatments; for instance, if one life-saving drug was to be approved for one person that costs £40,000, it would theoretically come at the expense of the lives of two people whose requests for drugs that cost £20,000 each were denied.
Calculating the costs of “dealing with” the coronavirus pandemic is certainly not simple. Billions are being invested in a vaccine – billions that could be spent elsewhere (including on adding hospital beds, recruiting more staff etc.). Millions have lost their jobs and are being compensated in part by governments that lack the money to do so – and that money will end up coming from somewhere, even though we’re trying not to think too much about that right now. Tax revenues from shuttered industries are dropping, sometimes drastically, possibly never to recover in full – and that too will have to be compensated for, most likely by tax increases along the line and by interest paid on loans taken out – from China, perhaps?
And there are other, hidden costs too – both financial and social. Some of the social costs are becoming evident – delayed operations for “non-emergency” procedures that nonetheless cause an extension of suffering for those in need of, say, a hip-replacement. Screenings for cancer have also been postponed or cut back, and this could lead directly to a loss in lives where diagnosis only occurs at a later – or too late – stage. And what about the elderly, cut off from social contact as they shelter at home – only to die there, alone and undetected, for days or even weeks? There have been approximately 190 such cases in Israel alone since the outbreak of the pandemic, and that’s just the cases that ZAKA knows about, because they were the ones called to deal with the decomposed remains of coronavirus’ hidden victims.
Despite all the obstacles in the way of calculating the cost of the pandemic, however, experts from the UK’s Department of Health and Social Care have come up with a tentative figure for the number of life years that could be lost if the government took no action whatsoever to stem the pandemic. They estimate that figure as three million life years. Taking into account the direct costs absorbed by the government in the measures they have taken to combat the coronavirus, that works out at around £180,000 per life year – that is to say, six times more than the usual threshold for saving lives in any other manner for any other disease.
Or, in other words, the lives of coronavirus victims are being essentially deemed more valuable than those of six victims of other diseases.
There’s another aspect to consider as well. All the billions invested in vaccine research, compensation for business owners and laid-off employees and so forth, could have been instead invested in improving social conditions that have been shown in study after study to contribute to higher rates of coronavirus morbidity and mortality. It is no longer a matter of dispute that inner-city areas where people live in cramped conditions and have less access to and less buying capability for healthy, fresh food are seeing much higher coronavirus rates than more affluent neighborhoods. Despite the insistence of the privileged that “coronavirus affects all of us,” it undoubtedly affects some more than others, in many cases (if not all) through no fault of those impacted.
Due to the politicized nature of the debate over coronavirus regulations in many countries, the question of how much we should be investing in often questionable and usually contentious ways of dealing with the virus probably hasn’t been given the prominence it deserves. People are also terribly squeamish when the question of “how much is life worth” comes up.
But the question of “how much is life worth” is one that society needs to answer – not just in relation to coronavirus, but in relation to all kinds of social questions that we face each and every day. If we, as a society, end up really, honestly, having this debate, then that may just be one unanticipated and welcome result of the pandemic.