THESE DAYS, CYNTHIA Leto ponders a timeless ethical question: how much is a person’s life worth? A cancerous tumor about the size of a walnut occupies the center portion of the 47-year-old Somerville resident’s brain. As a result, Leto has had to endure one debilitating symptom after another, the most prominent of which is chronic, excruciating pain.

But treating her condition costs serious money. Currently, Leto takes eight prescription drugs that total as much as $22,692 every year. The annual price tag is not paid by Leto, who receives a meager yearly income of $7632 in federal disability benefits. Instead, it’s picked up by the state Division of Medical Assistance (DMA), which administers Medicaid (known as MassHealth in this state), the joint state-federal health-care program for the poor.

Two months after Leto’s physicians placed her on a new and improved pain medication last year, however, the state DMA refused to foot the prescription bill. It’s not as if this particular drug were in experimental stages — a type of medication the agency routinely declines to fund. Nor has it failed to prove helpful. In the two months that Leto had received insurance coverage, in fact, the medication not only gave her instant pain relief, but also made her feel, she says, “better than I’ve felt since I got sick.”

Even so, DMA officials refuse to cover the medication’s costs. They say that the wonder drug was prescribed improperly in Leto’s case. Their decision has managed to save the cash-strapped state agency, which provides health care to 925,000 residents statewide, nearly $10,000 in additional expenses — expenses associated with just one MassHealth member. All of which explains why Leto doesn’t buy the agency’s explanation. “The DMA isn’t looking at the patients,” she says. Officials, she adds, “don’t know what I’m going through. They’re just sitting on some board saying no to the bottom line.”

LETO IS hardly the first person to bump up against the increasingly business-driven health-care system in the United States. But her current predicament shows the balance that insurers must strike between providing high-quality medical care and holding down explosive costs. This is particularly true when it comes to prescription drugs. Right now, the US spends more money on medications than any other country in the world. According to the National Institute for Health Care Management, in Washington, DC, spending on prescription drugs in this country rose as much as $20.8 billion from 1999 to 2000 alone — growing at a rate three times higher than medical expenses overall. This year, experts say, Americans are expected to shell out close to $160 billion for their medications.

Soaring prescription-drug costs have become one of the most troubling issues facing the US today, to be sure. The higher drug prices rise, the more insurance companies scramble to contain costs — and the more patients, even chronically ill patients like Leto, get squeezed. According to Wendy Mariner, who teaches health law at Boston University’s School of Public Health, the raging battle between cost and care is “a classic problem of who’s entitled to what, and from whom.” Explains Mariner, “It’s the perennial question of whether health care is a commercial ... or a social good.” Until we as a country resolve that debate, she adds, people like Leto — the sickest and most vulnerable among us — will always have to fight to get coverage for basic health-care needs.