What collective value should be placed on health? A question reopened by the health crisis.

Summary Nothing is more important than human life": this principle stated by the President of the Republic in his speech of October 28, 2020 illustrates how much the Covid crisis has reshuffled the deck in terms of thinking about the cost of health care. The right level of public spending on health care has been the subject of intense debate for several decades. Whether it is to reimburse very expensive innovative therapies, to build a hospital, to organize systematic cancer screening, or to confine the country, the question is obvious: what is the right level of spending to protect health and save lives? This is the purpose of a discipline in its own right, which is now present in the health agencies of many countries: medico-economic evaluation, which is capable of comparing the costs of an investment with the health gains that it generates for the community. This evaluation is far from the cynicism that is sometimes attributed to it: it combines a utilitarian viewpoint of maximizing aggregate collective benefits with normative principles of social justice that value the protection of the most vulnerable. In France, academic reflection on these issues, as well as their operational implementation by the Haute Autorité de Santé, have advanced the debate and transformed practices since the early 2000s. But there is still a fundamental question that the public debate must address in order to better guide our collective choices: the expected benefit of increased spending. It is not a question of setting a ceiling on expenditure per patient profile or per type of care. The objective is to develop a tool to evaluate the benefits of a treatment for a patient in terms of time saved and quality of life. Below a certain threshold, which will have to be the subject of public deliberation, a health investment would be considered unfair, because it would divert resources away from other more relevant priorities, i.e. other patients. In a context of constrained resources, the value of a life saved remains an open question, on which public action in health needs to be better constructed today.