“You can’t put a value on human life.” It’s a statement of the obvious, a truism, a banality. But that doesn’t get you out of having to make hard choices.
Already, in every healthcare system, clinicians are forced to make a value judgment every time they decide whether or not someone should be resuscitated. Politicians, too, need to decide how to make use of finite resources. Although no one likes to dwell on it, their choices frequently affect the mortality rate.
Consider an extreme example. Every day, about a hundred people in the United States die in traffic accidents. If it were illegal to manufacture a car that could move at more than 10 miles per hour, that figure would fall to approximately zero. But the damage to the economy would be so vast that there would be an immediate and tangible decline in longevity — which, in every society, correlates with wealth.
Is that a ghoulish calculation? Perhaps. But governments make it all the time. They even have a formula to calculate “quality-adjusted life years.” Again, it may appear distasteful to put a higher value on some lives than others, but most of us can appreciate the difference between the death of a healthy 5-year-old and the death of her bedridden 90-year-old great-grandmother.
Which brings us, of course, to COVID-19. When President Trump says, “we can’t have the cure be worse than the problem,” he is confronting people with this disquieting calculation. But he is also doing his job. Someone has to work out the impact of these trade-offs. Part of the burden of leadership is having to shoulder that dreadful responsibility.
Let’s put the question bluntly. How much poverty should we be prepared to inflict on ourselves to contain the spread of the virus? At what point will the preventative measures cause more deaths — or, to be precise, cause more QALY to be lost — than the disease itself?
The short answer is that no one yet knows, because there are so many imponderables. No one can say how harmful the coronavirus would be if left unchecked. And although we can put a rough price tag on the bailouts, we can only guess at the indirect costs associated with lost productivity and misallocated resources.
A few brave economists and commentators have had a go anyway. At the National Review, Robert VerBruggen notes that we have no idea what the counterfactual is — in other words, how much economic damage would happen anyway because of people staying away from restaurants and stores without any government instructions. Nor do we know what would have happened to the economy even without the virus. Then again, “we do have a few estimates we can stitch together, and we’re all inside and bored, so why not?” According to VerBruggen’s necessarily sketchy approximations, the economic damage that would be caused by hospitalizations and deaths would be much worse than that caused by the containment strategy.
On the contrary, Eline van den Broek-Altenburg, an assistant professor in Vermont, calculates that, measured by QALY, the cost of the shutdown is greater than we would countenance in any comparable medical emergency and will probably not be justified. Full disclosure: I knew van den Broek-Altenburg when she worked in Brussels nearly 20 years ago, and she is a very clever woman.
In Britain, Philip Thomas, professor of risk management at Bristol University, has been reckless enough to put a precise figure on it, arguing that once the containment measures cause the economy to shrink by more than 6.4%, they will have cost more lives than the virus itself.
My point is not that any of these estimates is accurate — all the authors stress that they are dealing with inadequate data. My point is simply that we need to be running the cost-benefit analysis all the time, updating it as new evidence comes in, ready to lift the restrictions the moment we can.
This point needs stressing because, as things stand, the incentives are all pulling the other way. Governments know that they will be judged by the number of coronavirus deaths, not by the necessarily intangible number of deaths caused by their containment measures. It’s a version of what the 19th-century economist Frederic Bastiat called “the seen and the unseen.”
If, for example, Michael Levitt, the Stanford biophysicist and Nobel laureate, is right that the outbreak is already peaking, there will nonetheless be overwhelming pressure on governments to err on the side of caution, to keep the restrictions in place for a little longer. Yet those restrictions are themselves lethal. It’s not a question of “money versus lives,” it’s a question of “lives versus lives.”
