The Price of Vitality
When health becomes currency, no one can afford to pay
They say the system is perfect, but perfection always comes at a cost. I should know—I helped build it.
In the 22nd century, health isn’t just a right, a privilege, or even a commodity. It’s currency. Every breath, every heartbeat, every productive hour has a price tag. And for the vast majority of us, that price isn’t something we pay—it’s something calculated for us, by algorithms so complex even their creators can’t fully explain them anymore. They call them Quality Adjusted Life Years. But who’s quality is it?
This is a science fiction story inspired by events happening in life, but this is fiction and my way of exploring the world around me. I’d love your thoughts and feedback!
I’m Dr. Eliza Marlow, a bioethicist by training and a cog in the machine by profession. I used to believe in what we were doing. When the Health Productivity Bureau was established, we promised a future free from the inequalities of traditional health care. No more arbitrary insurance plans. No more bankruptcies because a parent had the wrong kind of cancer. No more waiting lists for life-saving treatments. Instead, we’d use AI to create a system where resources were allocated efficiently and equitably. At least, that’s what they told us.
What they didn’t tell us—what I didn’t fully realize until it was too late—was how easily that efficiency could be weaponized.
The system works like this: Everyone’s health is monitored in real-time, thanks to biochips implanted at birth. The sudo-science fiction piece of technology invented by one of the oligarchs in the name of brain-computer interfaces. These chips collect everything—your vital signs, your medical history, your genetic predispositions. The data feeds into an algorithm that calculates your Vitality Score, a single number that determines how much health care you’re “worth.”
If your score is high—let’s say you’re a young, productive worker in a critical industry—you get the best treatments. State-of-the-art supplements to boost your endurance, nanobots to repair tissue damage, even cognitive enhancers if your job demands it. You’re kept in optimal condition because the system deems you valuable.
But if your score dips—if you’re injured, chronically ill, or simply aging out of your usefulness—the algorithm starts cutting corners. Treatments are scaled back. Preventative care is deprioritized. Your body becomes a drain on the system, and the system doesn’t like inefficiency.
For those who fall too far, there’s the dreaded downgrade.
A health downgrade strips you of access to essential treatments. You don’t get the anti-fatigue patches that keep you awake during twelve-hour shifts. You don’t get the nanobots that repair your joints after years of repetitive labor. You don’t even get the pain suppressors that make it bearable. Instead, you’re left to deteriorate.
And then there are the uninsurables.
The uninsurables are the people the system has completely written off. Maybe they were born with genetic conditions that made them “expensive” from the start. Maybe they accumulated too much medical debt after a workplace injury. Or maybe they just stopped being profitable.
Once your Vitality Score hits zero, you’re expelled from the insured zones and sent to the Greylands. Officially, these zones are described as humanitarian enclaves, places where people can live off the grid. In reality, they’re death sentences. The Greylands are wastelands—no infrastructure, no services, no law. Just a patchwork of barter economies and makeshift shelters where the uninsurables wait to die.
This dystopia wasn’t inevitable. It was engineered.
At the top of the system are the oligarchs—a cabal of trillionaires who own everything that matters. The hospitals, the pharmaceutical companies, the biochip manufacturers. Even the algorithms that run the Health Productivity Bureau are proprietary systems licensed from their corporations. They call themselves the Health Equity Board, but no one takes that name seriously anymore. They’re not stewards of equity; they’re gatekeepers of life itself.
The oligarchs didn’t just create the system—they perfected it. Health isn’t just a public service to them; it’s an investment portfolio. And like any good portfolio manager, they expect a return. That’s why the system prioritizes productivity above all else. It’s not about making people healthier; it’s about making them more profitable.
And it works. For them.
When I started working for the Bureau, I didn’t see it that way. Back then, I thought I was part of a revolution. My expertise was in bioethics, and I was brought on to help design policies that balanced efficiency with humanity. I wanted to make sure the algorithms didn’t lose sight of the people behind the data.
But as the years went on, I realized my role wasn’t to act as a moral compass. It was to give the system a veneer of legitimacy. Every ethical concern I raised was met with assurances that the algorithms were too sophisticated to be biased, that the data didn’t lie. And for a while, I believed it.
I told myself the downgrades were necessary trade-offs. That the uninsurables were a statistical inevitability. That the system, for all its flaws, was still better than what we had before.
I told myself a lot of things.
The truth hit me like a punch to the gut the day I first heard about Project Vitae.
It started as a rumor, a whisper in the Bureau’s halls about a new initiative that would “redefine health care.” Officially, it was an experimental biochip upgrade designed to improve real-time monitoring. But the leaked files told a different story.
Project Vitae wasn’t just about monitoring—it was about control. The new chips didn’t just collect data; they manipulated it. Pain, hunger, fatigue—these signals could be suppressed or amplified at will, turning workers into obedient machines. Compliance wasn’t just encouraged; it was biologically enforced.
The trials were conducted on uninsurables in the Greylands. People who had nothing left to lose—or so the oligarchs thought. The files described how the chips altered behavior, stripping subjects of their autonomy. Side effects included memory loss, emotional volatility, and, in some cases, sudden organ failure.
It wasn’t health care. It was slavery.
I wish I could say I was shocked, but part of me wasn’t. Part of me had seen this coming.
The oligarchs didn’t care about healing or justice or equity. They cared about maintaining the system that made them gods. And Project Vitae was the logical next step in their evolution.
But this time, they’d gone too far.
Now I’m sitting in the Archives, staring at the screen, watching the pieces fall into place. Every name in the database is a reminder of what I’ve enabled. Every Vitality Score is a number I helped create. And every time I press “approve,” I’m signing someone’s death warrant.
But I’ve also seen something else.
I’ve seen cracks in the system. Jonas Steele, a factory worker from GreenTech Facility 113, was one of the Vitae test subjects. He wasn’t supposed to survive. But he did. And he’s not staying quiet.
Jonas introduced me to others—people in the Greylands who are fighting back. They call themselves the Reclaimers. They’ve been gathering evidence, building alliances, and searching for ways to take down the system from the inside.
And now they have me.
I don’t know how this ends. Maybe we’ll succeed, and the system will collapse under the weight of its own cruelty. Or maybe we’ll fail, and the oligarchs will tighten their grip until there’s nothing left to fight for.
But I do know one thing: I can’t keep pretending the system is perfect. Because perfection always comes at a cost. And this time, the cost is too high.