The high cost vs. the value of life during the Covid-19 pandemic
WASHINGTON: President Trump says we can’t shut down the economy over SARS-CoV-2, the Wuhan coronavirus, forever. He is saying we can’t keep America shut down over Covid-19 forever. He is asking us to consider the cost vs. the value of life, even if he doesn’t say so.
He declared in his Saturday press briefing,
America will again, and soon, be open for business—very soon—a lot sooner than three or four months that somebody was suggesting. A lot sooner. We cannot let the cure be worse than the problem itself. We’re not going to let the cure be worse than the problem.
New York governor Andrew Cuomo responded angrily to Trump’s remarks:
My mother is not expendable and your mother is not expendable and our brothers and sisters are not expendable and we’re not going to accept a premise that human life is disposable and we’re not going to put a dollar figure on human life.
A predictable political storm has developed since Trump made his remarks. It comes down to the even more predictable argument, “Republicans favor Wall Street over human lives”.
Let’s start from two simple propositions: Every human life is valuable, but not infinitely so; and, everything valuable has a cost.
The Covid-19 pandemic calls Cuomo’s assertion into question on multiple counts.
First, the pandemic’s economic impact is vast, directly and as a result of social distancing measures. Those measures, designed to bring the pandemic under control, have shut down vast swaths of the global economy. Unemployment is surging, with 3.3 million new jobless claims last week.
On top of that, the economy will shrink by 25 percent or more in the second quarter of this year.
Lost GDP is a real expenditure. In this case, it will be an expenditure of at least $2 trillion to slow the spread of the virus. And that’s before we factor in a bailout bill or the cost of the flood of bankruptcies that will follow this disaster.
If this GDP loss saves a million lives, they’ll come at a cost of at least $2 million each. It’s likely that it will save far fewer, and the cost per life will be far greater.
The claim that Covid-19 will, in the U.S. as in Italy, overwhelm medical facilities forces us to confront an ugly question: Who should live, and who should die?
But that question isn’t new.
Nearly 750,000 Americans suffer from end-stage renal disease (ESRD); 100,000 are on kidney transplant lists. But last year, there were only 21,000 donor organs available for transplant. Those who don’t get transplants go on dialysis. Which treatment a patient receives has a huge impact on life expectancy.
After five years on dialysis, the survival rate is 35 percent; five years after a kidney transplant, the survival rate is 97 percent.
So, every year, the people who decide who gets a transplant are selecting patients’ odds of survival. They decide who lives and who dies. The same is even more true of the people who decide who gets a heart or a liver. If you need one and don’t get one, you die.
We anguish over the question now because it’s hitting so suddenly and so spectacularly.
Triage has always been a fact of life, though. Everything valuable has a cost, and the cost of saving a human life will grow and grow without bound until we’re forced to say, “enough.”
If the value of human life is finite, what is it? That depends. You might tell your sweetheart that you’d give the sun and the stars and the moon for her. “That’s a lovely thought”, she might answer, “but what am I worth to you in cold, hard cash?” How much cold, hard cash will you pay for the life of a loved one? How many resources should we devote to saving a single life?
One percent of Medicare patients suffer from ESRD, yet ESRD treatment consumes 7 percent of the Medicare budget. That’s money that can’t be used to treat something else, to save someone else.
Our demand for medical care is potentially limitless. We would sacrifice almost anything – including the wealth and welfare and lives of people we don’t know – to preserve the lives and health of those we love. Do you consider that extreme? Stories about people who demand that their children and parents remain hooked up to machines in hospital ICUs are common.
That’s hugely expensive, but people who don’t have to pay that bill will gladly spend the money.
As a society, we’re accustomed to that kind of expenditure. Covid-19, though, presents us with an entirely different scale of cost. And it’s a cost we can’t afford to pay indefinitely.
Whether America should open for business by Easter or by Memorial Day is a question I can’t answer.
However, it’s essential that we think in terms of opening it for business. We’ll be paying the costs for this year for decades. Costs will include schools permanently closed, jobs permanently lost, savings wiped out, homes lost, and elderly people forced to work into their 70s.
They’ll include medical care not received, inflation, infrastructure not repaired, and more than we can possibly imagine.
Human beings are social animals, and as social animals, we have to be concerned about the people around us or our society will crumble. But there’s nothing wrong with demanding that we consider the costs. It’s irresponsible not to. And to understand the costs, we need to know the nature of the crisis facing us. We need to know how many people are infected, what the true death rate of the disease is, whether it will persist as a seasonal infection or burn out, whether we can develop a vaccine.
That information all has a point: It lets us know the costs and benefits of pursing different paths to stop Covid-19. The best path could be the one we’re on, or putting the elderly and sick in coronavirus-free islands, testing everyone who tries to enter their facilities.
It could be to go back to work by Easter.
President Trump is wrong if he thinks he knows the answer, but he’s absolutely correct that the American people need an answer. We can’t afford to shut down the economy for long. We’re willing to pay a high price to protect the lives of people at risk of serious disease.
A Great Depression is a higher price than we’re willing to pay.