Many of us remain blissfully unaware that price tags are constantly placed on our lives, even as these calculations infiltrate many of our most important decisions. These value judgments affect nearly every aspect of our existence from the air we breathe to the food we eat. They drive personal decisions, ranging from life insurance to health care to when (or whether) to have a child.
Not only are these price tags nearly ubiquitous, they’re often inevitable. But we rarely talk about them openly. Until now.
Choices health care workers are having to make — or consider making — around COVID-19 and the value of human life are making headlines around the world. In the United States, we’re not used to doctors being faced with a Sophie’s choice of which patient to try to save and whom to let die when resources run short. Anticipating a worst-case scenario, one that hopefully won’t arrive, Massachusetts health officials issued voluntary guidelines on rationing ventilators that prioritize medical personnel, pregnant women, and healthier individuals with longer life expectancies, the Globe reported recently. In the case of a tie, younger patients would be favored.
We are now beginning to face another urgent question: When does increasing the risk of preventable death become “worth it” to save the economy? Regulatory agencies regularly perform this kind of cost-benefit analysis, such as when deciding acceptable levels of arsenic in the water or safety requirements in our cars. But the COVID-19 pandemic is fraught with uncertainties and far-reaching implications — significantly greater in complexity and potential impact than the typical situations faced by regulatory agencies.
Not that analysts at the Food and Drug Administration, the Environmental Protection Agency, and elsewhere don’t already have tough enough jobs. Once they determine how many additional lives might be saved by raising the standards of water supplies or car safety, for example, they then have to convert those lives into dollars. Today, the risk of preventable deaths is given a price tag of about $10 million per life, a measure known as the “value of a statistical life.” America’s regulatory agencies currently all subscribe to the principle that “all lives are valued equally,” meaning all lives have the same value regardless of age, wealth, health, or other factors.
This principle of equality stands in stark contrast to the vast inequalities we see every day in American society. People earning minimum wage receive an annual salary of about $15,000, while finance industry leaders can earn hundreds of millions or more. Racial income disparities are especially notable: The median household income in 2017 for white households was $68,145, compared with $50,486 for Hispanics and $40,258 for Blacks, according to the Census Bureau. And now the ability to work remotely during this pandemic further exposes sharp divides of educational attainment and race. There are many reasons why this pandemic is having a larger impact on people of color, but the tragic reality is that in many parts of America, essential workers — such as grocery store employees and health aides — are being more exposed to the virus and some are dying because of it.
Debates over who is most at risk for coronavirus, who should receive priority for ventilators, and when to reopen the economy really all boil down to a single question: How much are our lives worth?
It’s a deceptively simple question. Could you say how much you’d pay to save the life of a stranger, a friend, a lover, a child — or even yourself? The complexity of the answers resides in the fact that how we arrive at a price tag on life says a great deal about our priorities. These price tags are markers of what we define as just, infused with influences from economics, ethics, religion, human rights, and law.
Estimating the amount of money needed to replace your income should you die unexpectedly, when buying life insurance, has one purpose and perspective. But the calculus is different for a government trying to figure out how much lives should be valued to prevent environmental risks or stave off an economic crisis. And it continues to vary, sector by sector. Medical decisions are often based on profitability algorithms and affordability assessments, because no health system could function otherwise. Is the treatment cost-efficient for the insurance company? Can the patient afford to pay out of pocket? No for-profit company could implement every conceivable safety device and remain in business. They too rely on cost-benefit analyses to guide their decisions.
Universal truths have emerged in my research into how lives are valued: The price tags routinely placed on human lives have major ramifications, yet are often neither transparent nor fair. Undervalued lives are left underprotected and more exposed to risks than more highly valued lives. Many workers on the front lines of the pandemic are recognizing that their occupational risk is not being fairly rewarded and are demanding, and sometimes receiving, hazard pay. Recently Massachusetts approved hazard pay for some health care workers while states from New York to Maine to Texas have either implemented hazard pay policies or are considering them.
Technical language and legal jargon often obscure the methods that economists, regulators, business analysts, and health care and insurance companies employ to estimate values of life. But we must try to understand how this work is done because the methods and price tags speak to our priorities as a society, reflecting our core values and what we define as being just. When these equations are infused with gender, racial, national, and cultural biases, the resulting price tags are fundamentally unfair.
Given how critical these price tags are to everyone’s lives, we have to keep discussing them outside of the small universe of technical experts. Ignoring how life is valued in monetary terms leaves us susceptible to risking what matters most: our health and safety, our rights, and the lives of ourselves and our families. Only with knowledge and vigilance can we can ensure that all lives are treated fairly, valued equitably, and sufficiently protected.
Howard Friedman is the author of Ultimate Price: The Value We Place on Life, University of California Press. He’s an adjunct professor at Columbia University. Send comments to firstname.lastname@example.org.