How Risky Is It, Really?

Why our fears don't always match the facts

The Heartlessness of Health Care Cost Control as You Watch a Loved One Die

We can't afford all the care we want, but we want it all.

As part of considering the costs and benefits of major regulations, the federal government assigns a dollar value to human life. This is not a real person, not the loved one close to me who is in his final physical days. It is just an imaginary statistical average life, calculated using some semi-fancy math to establish what the wonks call the Value of a Statistical Life, or VSL. Converting lives into dollars allows policy makers to compare the human health benefits of the regulation, apples-to-apples (dollars to dollars), against the costs of implementing the rule. Cost Benefit Analysis is a helpful tool for identifying whether potential regulations are “worth it”.

I understand how they calculate the value of a statistical life, and a bit about Cost Benefit Analysis, and I support both as tools that can help inform government decision making about how we can use our resources most efficiently. Intellectually. But these days, as I sit at the bedside of a close family member in hospice care, I also understand, at the deepest emotional level, how patently offensive it is that policy makers could dare put a dollar value on human life, no matter how hypothetical and ‘average’ that statistical life may be.

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His eyes are glazed and distant, eyes that use to shine with pride and happiness into my life. His face, once so full of warmth and vigor, is pallid and shrunken. The hand that held me and steadied me is too weak to even grip my finger. These eyes and face and hand are the features of a real person, not some numeric abstraction. What are they worth?

The lessons he taught, the laughter and the tears that his life gave mine, the moments we shared and the inspiration he breathed into me…these are deep parts of the true meaning his life has had for me, and for so many others. Where do these true values of a human existence show up in the cold calculation of the Value of a Statistical Life? Of course, they don’t.

Nor do they need to, since Cost Benefit Analysis is just the cold economics of a policy option, an objective calculation of only one aspect of a policy choice. The final decision on those choices must also be informed by an open and full and rigorous exploration of our values and feelings…the subjective, emotional and ethical aspects of the issue being considered. The monetary component is just one part of what determines which rules we as a democratic society adopt. But it is an important aspect, and I know that it's valuable to study that aspect objectively and know what those numbers say. Such analysis, callous as it may feel, makes for more intelligent decision making, and smarter and more effective rules for all of us.

The problem, as I am discovering first hand as I sit by my loved one’s side in his final days, is that policy is made for all of us, but we…you and I….live down inside our own individual lives. Policy making and Cost Benefit Analysis are impersonal and intellectual. Our lives are personal and emotional. We don’t live statistical lives. We live real ones, with real people and real experiences and all sorts of powerfully, poignantly real emotions, feelings that often fly in the face of what might make the most rational sense.

Intellectually, we all want to control health care costs, for example. It seems perfectly logical, important, valuable, for policy makers to measure the cost-effectiveness of various forms of treatment so we can invest more in the ones that provide the most health benefit per dollar spent. That makes perfect sense. In our heads. Theoretically. But such ideas are meaninglessly abstract in the emotional reality of our actual lives, where real people get sick, and need care, and we want our family members or friends to have access to all and any care that might help, and “the system” and statistics and the bigger picture be damned.

I want my loved one to get all the medication and medical attention that will carry him through his final days in comfort. I want to see him smile. I want to see all the family members who kiss him goodbye at peace, each of them knowing their loved one has gotten all the care he could get…all the care each of us will probably want when our time comes. Economics, and rationality, and the bigger picture, have no place here. They are preposterously heartless, an affront to and in callous conflict with what my heart wants for this gentle strong spirit as he lives his final physical days.

What’s the value of his life? That can only be truly calculated in my heart and in the hearts of those who have known him and loved him, and by all the contribution his career as a journalist has had on the wider community. Those are not monetary measures. The Value of a Statistical Life!? What utter nonsense at a time like this. An important part of an important process for making wise social policy? Yes, I still know that, in my head. But right now? In my heart? What spurious meaningless soulless nonsense.

David Ropeik is the author of How Risky Is It, Really?, an Instructor at Harvard University Extension School, and a risk-communication consultant.

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