With all the talk and FUD (Fear, Uncertainty, and Distrust) flying around about health care costs, health care reform, and health service rationing, one issue we've all been dancing around is the value of life -- specifically, the value of a particular human life.

I'm not going to apologize for ruffling feathers here -- there is no single answer or set of "right" answers, and all values are influenced by community, religion, financial affluence, and direct relationship to the individual being evaluated.

That health services are in some way rationed is axiom. Whether it be by ability to pay more for care, life-threatening need (triage at the site of a large-scale medical emergency), or availability of services (long wait times to see the only endo in five counties), the concept of "unlimited medical services for every single person on earth, at all times, affordably" is a fiction that does not -- and economically, probably cannot, exist.

While the current conflagrations have centered mostly around senior citizens and "end of life planning", the concepts of cost-effectiveness and "the needs of the many" suggest that we, as people with diabetes, should be concerned as well.

Almost every person on this site is -- or should be -- fearful of the possibility that health service rationing will deprive him of his insulin pump, his CGM, or even his insulin (and/or oral medications). Today, this might be due to lack of health insurance and its negociated discounts. In a system in which all care draws from a single dollar pool, one must weigh the retail cost of a month's worth of insulin and pump supplies against dozens of flu vaccinations. One year's worth of pump supplies might pay for an appendectomy that would let someone else live another 40 years. In a straight-budgeted (no overruns allowed) dollars-and-cents, all-lives-are-equal analysis, people with diabetes are (and possibly should be) somewhere down on the priorities list.

But all lives are not of equal value.

That is not to say that the intrinsic value of being alive varies from person to person, but rather that the ability of a person to contribute to the community's overall wealth varies, as does the total value of what he is projected to contribute to society through the rest of his life. In general, the younger a person is, the longer his projected lifespan and the greater opportunity for him to contribute something of magnitude to the community. On the other hand, one's expected contributions might be projected by examining his contributions over, say, the five years immediately past. Based on total-value monetary return on investment, one might find greater value to society by assisting a fifty-year-old university professor to live another five years than by assisting a thirty-year-old day laborer to live another twenty-five. This sort of care rationing would create a meritocracy in which in order to maintain medical services, one must constantly prove his value to society.

There are other factors to consider as well. There is the personal factor of attachment to our sick children and our elderly parents, and the empathy we hold for friends and colleagues. There are the children that inspire people to "adopt a child" through Plan International, or to give money to St. Jude's. There is a wealth of non-pecuniary ways in which each of us touches the lives of every other person we encounter. If a storefront preacher's sermon helps a "street bum" get off drugs and get a job helping other people do the same, is that not worth something beyond what is indicated by his meager salary?

Consider every person listed in dLife's Fame Pages. Each has contributed to the wealth and beauty of life around us. Now consider what might have happened had that person not been diagnosed -- not been given insulin (or the appropriate oral medications) -- not been allowed to live long enough to become famous and to inspire people to reach for the highest goals, to learn, to entertain, and to help others. That, too, is the value of a life.

(The same could be said of any person on the dLife Wall.)

The choices we make, both individually and as a society, need to encompass both our intrinsic value and the value of our contributions to that society. To do any less is to shortchange ourselves, our communities, and our Deities.

How we make those decisions is up to us.