(Let me note that podcasts really made running on a treadmill in the winter not torture.)
Radio Lab did a podcast a few weeks ago on worth. They discussed a few topics on what things are worth, and one of those was on how much is a year of life worth. The rationale was that there are now cancer drugs that cost $1000 or more per pill. These are pills that you might have to take for months. The noted that there are some (extremely expensive) pills now that will actually cure you of deadly diseases, and there are some that will only extend your life by a couple of months. One drug that they highlighted cost on the order of $1000/pill and would extend your life by an average of ~35 days. They further noted that this was for only one pill, and not for the ~10 extra pills that you have to take that help maintain some quality of life while the poison in your veins destroys the cancer. It also doesn’t include the doctors visits or the nursing care or whatever. So, they suggested that the real prices isn’t $1000/day but could be something substantially more than that.
That made them ask the question, what is a year of life worth? Or, what is 35 days of life worth? There were two main reasons for asking this:
1. Let’s say that you actually have a fair bit of money and can pay for these pills yourself. Would you pay $100,000 to have (possibly) 35 extra days of life? Would you pay a million dollars to have an extra year of life? What happens if you don’t have this much cash laying around? Does society (in the form of insurance) pick up the tab?
2. If society does pay, then do they get a say in the value of your life? Do they get to decide how much is too much? What about if you could get an operation that would give you a month of time, but would cost a million dollars. Should society pick up that tab? What is the limit? And who qualifies? If everyone gets this operation, then it costs everyone a million dollars and society is back to square one (if everyone is special, then no one is special!)
In the society we have now, the wealthy have access to life extending drugs and operations because they can afford them. There are plenty of books and movies that take this to the extreme and describe a society in which only the wealthy have access to life prolonging procedures, and the poor, uh, don’t like it.
With the Affordable Care Act, we now have a means to allow everyone access to these life-prolonging drugs. I think that the thought is that this is a supply and demand situation, such that in the early stages of a drug there are only a small quantity available, so the price is high. If everyone needs the drug, then the price goes down. Or, as the age of the drug grows, the price will go down. This must be what we are counting on, since we can’t give everyone a million dollars of cancer drugs.
Should there be a line that should not be crossed for what society will pay for drugs to extend a life by a given amount? Should that be age dependent? For example, we, as a society, would probably be willing to spend a huge amount for a 30 year old person, and not as much for a 95 year old person. If the drug cured you of cancer should society be willing to spend more as opposed to just prolonging the inevitable (ok, everything is just prolonging the inevitable).
This is pretty much exactly what we are talking about, but in a round-about way. We do this all of the time. When we put a price on how much money we spend on medical research, we are putting a value on a life. When we put caps on insurance policies, we are putting a value on a life. When we oppose regulations on cars and pollution and the food and drug administration, we are putting a value on a life. It is much harder to say what that value is, since it bundles up society as a whole and offers a perturbation on the statistical length of our lives, but it is still putting a value of time on some portion of our lives. Most of the time, this is what we are doing through government policies, and the direct cost of a life (or a year of life) is not discussed in such terms.
With the Affordable Care Act, as well as the proliferation of extremely expensive drugs, this discussion will be coming more front and center.
I would also like to make an analogy here. If someone came up to you and pointed a gun to your head and demanded $100,000, would you pay? If you knew with 100% certainty that they would pull the trigger and that your life would absolutely end, would you pay? This is the situation that drug companies have put people who have cancer. You have no choice but to pay, unless you want to die. So, while we are having this discussion about society paying and how much is a life worth, we are basically paying someone a huge amount of money to not put a bullet through our head (or to reduce the probability of the bullet going through our head).
What would happen if the government and insurance companies invested money into drug research instead of paying companies to develop the drugs? Would this end up being a cost effective route? Or do we need to give companies the power to put a gun to our head (or, more precisely, the power to dodge bullets) in order for them to have the incentive to develop these drugs?