Let’s say a drug has been shown to extend the life of terminally ill patients by months or even years. How much should we pay for it? Is there such a thing as a drug’s being too expensive? If we say “yes,” aren’t we putting a price on what a life is worth?

Suppose we have a rule that says we will pay for a drug that extends a patient’s life for a year, provided that it doesn’t cost more than $X. As we shall see, this is exactly what is done in Britain and other countries. If we follow suit, isn’t that the same thing as deciding that the lives of patients are not worth more than $X? And if so, aren’t decision rules like this one ethically abhorrent?

Here is the uncomfortable reality: We can’t avoid making decisions like this. And if today such decisions are rare, tomorrow they won’t be. The future holds the promise of a great many ways of prolonging our lives – potentially at great expense. If we are unwilling to spend the entire GDP on health care, someone has to say enough is enough.