What Is the Cost of Saving a Life?

Inside the system

By Rujjwal, physician and full-time wonderer. October 2026, about 9 minutes.

In his book Medicine's Dilemmas, William Kissick describes a deeply held American belief that "no cost is too great to save a life" (p. 2). Human life has no price; its value is greater than any monetary value, so there is no cap on how much we will spend to treat someone or keep them alive. This is as close as it gets to utopia: every human life is invaluable, and no resource outweighs the value of keeping a human being alive. This is what the pinnacle of civilization, prosperity, and humanity should look like. It fits the image of one of the most developed and wealthy nations in the world, a nation that holds human life in the highest regard, and of America as a country known around the world for charitable giving that exceeds the budgets of several small nations. It is an ideal state for a society to aim for. But are we there yet? Can we honestly claim that capacity for our society?

The reality check

In 2024, U.S. health care spending reached $5.3 trillion, about $15,474 per person and 18% of GDP. In 2022, the U.S. alone spent $4.5 trillion, nearly half of the $9.8 trillion spent on health worldwide that year. Per person, U.S. spending is about two and a half times the OECD average of nearly $5,000.

Much of that money is concentrated in a small group of patients. In any given year, the sickest 5% of Americans account for roughly half of all health spending, and the top 1% for about a fifth. Care near the end of life is especially intensive for people with terminal or incurable illnesses: Medicare beneficiaries who died in 2014 made up about 4% of traditional Medicare enrollees but 13.5% of its spending, at nearly four times the cost per person of those who survived the year. Spending near death, however, does not by itself mean care was futile or avoidable; we often don't know who will die until after the fact.

The budget pressure is substantial. Medicare and Medicaid together accounted for about $2.05 trillion, roughly 39% of U.S. health spending, in 2024. Federal health programs are a major part of mandatory spending, compete with every other national priority, and are one of the main contributors to long-term debt pressure. And the trend is not slowing: federal actuaries project health spending will reach about 20.6% of GDP, nearly $9 trillion, by 2034.

Who pays changes the question

So it is certainly not fair for a society to spend endlessly, even on health. Like every resource, health care is not unlimited; we need to ration it and prioritize spending where it is most needed, as we do with everything else. So what is a reasonable dollar cap for saving a life?

Somewhere in the underdeveloped world, it is entirely a question of capacity: health care is mostly about what you can access, and that largely depends on what you can pay. With private pay, it is very largely at the discretion of whoever is paying for the sick person's care. It is an entirely private matter, and it may depend on the family's financial capacity and on what the sick person means to them.

But when the payer is not a private party but a social safety net, such as insurance or the government, the question of wise resource allocation becomes far more meaningful. The sickest 5% already consume about half of the budget; if that share kept climbing toward, say, 80%, the remaining 95% of the population could be left with unmet health needs, which is equally unfair to them. In a rational and fair world, the life of a sick person has neither more nor less value than the life of a healthy one, so resource allocation has to be fair both ways. A system needs some design that caps expenditure from the top spenders, so the rest of the population is not left with unmet needs because a concentrated group used up the budget.

So the argument for a ceiling, or some system that keeps the rest of the population safe from the spending pressure of a small group, will draw pushback on humanitarian grounds. In the U.S., it already has: laws like the Affordable Care Act and the Inflation Reduction Act restrict the use of cost-per-life-year formulas, largely because disability advocates argued, with good reason, that those formulas count a year lived with a disability as worth less. I take that concern seriously, because it is the same principle I am arguing from. My point is not that some lives are worth more than others. It is the opposite: every person, sick or healthy, has an equal claim on the resources we share, and when one person's care consumes what others need, that equal claim is broken. Any cap a society sets should protect that equality, not undermine it. But refusing to set any cap at all is also a choice, and its cost is paid quietly by everyone whose care goes unmet.

Lessons from the bedside in Nepal

This consideration also comes up with private pay. Say someone's family member is sick, and they love them dearly. Even with everything said, and emotions aside, what is the most a person can spend to save a loved one's life? Say they have a terminal, incurable cancer or disease, or they are stuck in the ICU with survival uncertain for months, each day adding cost and straining the family's finances.

I used to see this a lot while practicing in Nepal, because most care there is paid out of pocket, so the decision to continue treatment or call it off always has to be made on the spot. You are not billed weeks after discharge and left to deal with it later. In Nepal, as in many places around the world, continuing treatment today means yesterday's bill has to be cleared first. So at some point, a family stuck in the situation I described has to put love and emotion aside and decide: can we continue another day? Because once it is all said and done, there will be mouths to feed and lives that need to go on.

I have seen it countless times. One father withdrew his son's ventilator weeks into a trial of weaning him off it, because each day of uncertainty meant more expense and more uncertainty for the rest of the family he had to look after. He pulled the plug. He chose the unbearable suffering of losing his son over the uncertainty facing the rest of his family. He chose the uncomfortable certainty.

He chose the uncomfortable certainty.

Those are individual decisions, and the threshold for reaching them may differ from society to society depending on financial status, culture, and more. In some cultures, like Nepal's, very old people who are terminally ill usually aren't taken to the hospital; they prefer to die at home surrounded by family, and families and society are used to that, with cultural practices designed around it. It takes a lot of financial burden off families and perhaps preserves dignity in death for many. It may also reflect a society's and a culture's own familiarity with, and acceptance of, death and the dying process.

When a society has to make the call

I see that less in the United States, and it is likely similar in many developed nations, for various reasons that would be another article for another time. But when we are talking about cost, it is the same thing: an individual cost multiplied across the total population. So individual cases can be extrapolated to the larger society. Imagine society in the same situation as the father above, with his son on a ventilator. When does a society let go of one of its members, the way that father let go of his son? If a parent has to make that call for their child, in what is considered the highest form of love and attachment in human relationships, then a society should also be in a position to make the call. How does a society make that call?

These kinds of questions arise when there is a need to make those calls. Some European societies do it: futile health care that burdens the patient or society may be called off by the doctor or by a joint decision of doctors. That is an example of a society making the call, putting some sort of cap on the burden or expenditure a society can take on for one member, accounting for all the other members who also rely on the same system when they are in need. England goes a step further and puts an actual dollar figure on it. Its National Institute for Health and Care Excellence (NICE), which decides which new treatments the National Health Service will pay for, generally recommends a new drug only if it costs no more than about £25,000 to £35,000 (roughly $33,000 to $47,000) per quality-adjusted life year gained, meaning per extra year of life lived in good health, with higher limits for very rare diseases. That range was raised in April 2026 from £20,000 to £30,000, where it had stayed since NICE was founded in 1999. Whether or not we agree with the number, that is a society openly answering the question this article asks. But as far as I know, such decisions are scattered, case-based, and largely made jointly with families. Only some cases become headlines, when the battle over when to stop treatment becomes loud in society. I recall the Alfie Evans case at Alder Hey Children's Hospital in Liverpool in 2018.

American health care doesn't function this way. As I said earlier from Kissick's book, this society holds the belief that no cost is too great to save a human life, and even while crumbling from inside, American society has so far shown resilience to that. We have countless cases of patients with no meaningful chance of survival or recovery, merely clinging to artificial life support with no awareness of their own, because a family member insists on continuing for reasons that are not medically grounded, despite ample education about the case and prognosis from a multidisciplinary team. Such cases add cost and resource burden to society, and such decisions may deprive another sick member of the same society of a needed ICU bed, ventilator, or skilled staff that could otherwise have been freed up.

Coming to terms with death

After all, as living beings, our lives are programmed with death as an inevitable part of life, and at some point society will need to come to terms with that: against nature, not every battle can be won, and not every battle is worth fighting. It may be wise to accept the fact of death and become comfortable with the process of dying, so that instead of exhausting all our resources fighting one death, we prepare ourselves as a society to allocate and care for the whole population far into the future. I think that is what makes us a resilient society. We are not giving up on any member of society; we are just coming to terms with the fact that every life has an end. No matter how much we spend to eliminate the top killer disease from the list, the second will take its place. And as a society, financially and culturally, we can build a framework for how much we are willing to spend on one person, or on a specific concentrated population that drains the majority of a society's resources and leaves large numbers of others vulnerable.

So, what is a life worth?

Since there is such a huge cultural aspect to how death, dying, and terminal illness are viewed and processed by a society, there is likely no single dollar value for how much a society can spend to save a life; we cannot agree on one number or value. However, I think most of us would not disagree that the cost of saving a human life should not be more than the burden it leaves behind for the survivors, be it a family or a society as a whole. I feel that is the most respectful and fair way to look at it.

The cost of saving a human life should not be more than the burden it leaves behind for the survivors, be it a family or a society as a whole.

Disclaimer: The views expressed here are my own and do not represent those of my employer or any institution I am affiliated with. This article is for general informational and educational purposes only. It is not medical advice and does not create a physician-patient relationship. Please consult a qualified healthcare professional about your own health.

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