Thank U.S. Health Care for the Life of Steve Jobs

Thank U.S. Health Care for the Life of Steve Jobs

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On the very day that Steve Jobs died a new report suggests that the U.S. health care system is spending too much money on people near the end of their lives. The timing of the two events could not have been more ironic.

Had Jobs been under the care of the British National Health Service (NHS) or the Canadian Medicare system, he almost certainly would have died two years earlier. That would have been a major loss for the world, by anyone’s reckoning.

Here’s the back story. In 2004 Steve Jobs was diagnosed with pancreatic cancer. He reportedly underwent successful surgery. Then, in 2009 he received a liver transplant. He died on Wednesday.

I haven’t seen Jobs’ medical records and I have made no real attempt to get the details about his medical condition. But for the point I want to make here, none of that really matters. Jobs’ case is interesting because of the issues it raises.

In most places in the world today a diagnosis of pancreatic cancer would be considered a death sentence. Aggressive treatment of the condition would be considered a poor use of medical resources — one involving considerable expense in return for only a few extra months of life. Perhaps Jobs’ cancer was of a rare variety that could be removed by surgery.

Even so, almost nowhere else in the world would a pancreatic cancer survivor be considered an appropriate candidate for a liver transplant. In Jobs’ case, the transplant apparently bought him only about two more years of life. In no other developed country would a patient get a liver transplant in order to live two more years.

In Britain, the National Institute for Health and Clinical Excellence (NICE) is charged with deciding which treatments the British NHS will pay for and which it will not. NICE considers a treatment cost-effective only if the cost per quality adjusted life year (QALY) is £20,000 or less (about $31,000). Since the cost of a liver transplant plus two years of follow-up care are greater than that number, in Britain Jobs would not have made the cut.

Overall, the British Medical Journal estimates that 25,000 British cancer patients die prematurely every year because they do not get access to life-extending drugs readily available on the European continent and in this country. The British government reasons that the extra months of life the drugs will allow is not worth their cost.

There are good reasons why Americans should care about this way of thinking. Former Senator Tom Daschle’s book, generally regarded as the blueprint for ObamaCare, praised NICE and recommended we follow a similar approach in the United States. Donald Berwick, who is currently in charge of Medicare and Medicaid, has also praised the NICE way of deciding who gets care and who doesn’t. They are not alone. Most health policy insiders — certainly those in the Obama administration — believe in health care rationing.

Americans should be thankful that in this country there is more respect for life. But even here we have a rationing problem. There enough people waiting for an organ transplant in the United States to fill a good sized football stadium, twice over.

Each day, an average of 75 people receive organ transplants. However, an average of 20 people die each day waiting for transplants that can’t take place because of the shortage of donated organs. Here is Austin Frakt on kidney transplants, the most common form of organ transplantation:

Today, the waiting list for kidney donations is about 85,000 patients long and growing. Total transplants per year numbers 17,000, over 10,000 of which are based on kidneys from cadavers. The rest are live donations. The costs in treasure and lives due to a lack of kidneys for transplant are high. Medicare’s ESRD (kidney failure) benefit cost the program $24 billion in 2007, or nearly 6% of the entire Medicare budget. Each year about 4,500 individuals per year die waiting for a transplant.

Which brings us back to Steve Jobs. I don’t need to tell you how important he was to our culture. His devices helped change the way consumers buy music, read books and enjoy movies. He was considered by many to be the greatest corporate leader of the last half century. He was compared to Henry Ford, Walt Disney and Thomas Edison.Kevin Williamson has a great tribute to Jobs at NRO. Here is David Henderson’s description:

He was an incredible entrepreneur who not only knew how to start a company but also how to keep coming up with new “insanely great” products as the company matured. If you want to see Jobs at his young impish best, watch this 5-minute video of his introduction of the Apple Macintosh when he was only 28 years old.

Plus, Jobs’ end-of-life care enabled him to keep pushing the envelope. Because of his never-ending devotion to innovation, we got the iPhone after he was diagnosed with pancreatic cancer and the iPad after his liver transplant.

So here is my question of the day: Should government (or a bureaucratic system sanctioned by government) be able to pick and choose among the potential organ recipients, based on their contribution to society? Or should the decision be made by lottery? Or in some other way?

Most economists I know think there is a better solution — one that doesn’t involve having to make life or death decisions about end-of-life care. If we were willing to compensate people for donating their organs in the case of an unforeseen death, more people would be willing to sign advance directives allowing their organs to be used to save the lives of fellow human beings. In fact, studies show that the need for organs can apparently be satisfied by willing donors for a price of around $15,000 a year for a kidney and $30,000 for a liver.

In addition to Steve Jobs’ technological contributions, a change in the way that we address the issue of organ donation may be yet another lasting legacy.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.

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53 Comments on "Thank U.S. Health Care for the Life of Steve Jobs"


Guest
Peter1
Oct 10, 2011

“Thank U.S. Health Care for the Life of Steve Jobs.”

“In most places in the world today a diagnosis of pancreatic cancer would be considered a death sentence.”

“On the very day that Steve Jobs died.”

Yea, that’s what I thought, he did die. Tell me Mr. Goodman, would an uninsured person deserve 2 more years of life?

“That would have been a major loss for the world”

I don’t know how we could have survived without the iPad.

Guest
Oct 10, 2011

Ask any question you like about any health topic
he’s very knowledgable … Blog.Vytayouth.com

Guest
Oct 10, 2011

Hmm…so Goodman is apparently unaware that Jobs got his liver transplant in Tennessee–a place he had no connection to–and apparently jumped the queue to do so. So perhaps some other AMERICAN died earlier because of him?

And it’s pretty ironic that the major study at Partners Healthcare on treatment for cancer patients showed that patients treated with palliative care OUTLIVED those who had aggressive intervention from Oncologists. So apparently patients in the same hospital in the same city in the same state in AMERICA can experience different treatments, and the aggressive intervention Goodman is so amazed about may actually not do any good to those who get it.

The general “better care in the US” argument has been completely disproven many times, and yet Goodman trots it out time and again. Even though the mechanism that drives the over-treatment in the US–Medicare reimbursement–is something he disapproves of. I don’t know how he manages to write this without smoke coming out of his ears..

Guest
twa
Oct 10, 2011

John #ihavenofactstobackthisup Goodman

Guest
K Murphy
Oct 10, 2011

He would have just paid for the treatment out of pocket. He had no need for insurance and could have gone anywhere in the world.

Guest
MG
Oct 10, 2011

One of the dumber Jobs-related tie-in articles I have seen the past several days and that is saying alot.

Guest
Oct 10, 2011

Wish this comment space had a “like” button.

Guest
MG
Oct 10, 2011

Jobs could have gotten whatever needed whenever he wanted. Taking a cue from South Park, Jobs could have afforded daily milkshake smoothies made of $100 bills if it had helped to keep the pancreatic cancer in check.

Guest
Devon Herrick
Oct 10, 2011

It’s impossible to know for certain how much time aggressive care bought Jobs or whether he would have lived as long with less aggressive care. However, it has been published far and wide that the U.K. has worse cancer care than the United States and much of Europe. I would be hard pressed to claim the United States gets nothing for the money we spend. At the very least the incremental increase in knowledge gained from oncology research will make a different in future years.

Guest
Nancy Metcalf
Oct 10, 2011

Sharon Begley, Newsweek’s ace science writer, is just out with a piece suggesting that the aggressive and no doubt very costly care that Jobs received may have shortened his life rather than extending it. http://www.thedailybeast.com/articles/2011/10/05/steve-jobs-dies-his-unorthodox-treatment-for-neuroendocrine-cancer.html

Guest
Oct 10, 2011

@Matthew Holt:

What exactly does having a “connection” with Tennessee have to do with getting a liver transplant there? Surely you don’t you believe that the Mayo Clinic should only treat people from Minnesota, or that the Cleveland Clinic should only treat people from Ohio.

Or are we going to see the Health 2.0 crowd develop an app to estimate someone’s “medical footprint” and claim that we should not use medical resources from beyond a certain boundary?

Maybe you could launch it at the Health 2.0 conference in New Delhi. But surely a San Francisco producer would never follow through with an event so far away, to which he has no “connection,” right?

Guest
Oct 10, 2011

Well, you’re an interesting guy. Hmmm.. And I take shit here for being caustic in pushback response to flamers. LOL.

I’ll have to read up on you and add you to my blogroll. Are you a “Tenther”?

Guest
Oct 10, 2011

Oh, wait. Pacific Research Institute. OK. I get it.

Guest
Oct 11, 2011

It’s impossible to tell if Jobs jumped the UNOS queue for his liver. but for sure he did not “patiently wait it out” in California. http://www.minnpost.com/healthblog/2009/06/22/9682/did_steve_jobs_jump_the_liver_transplant_queue
There were for sure Californians ahead of him on the California list who got their livers after him if at all.

And if a San Francisco-based conference launches a version in India, the market will bear its success (or not) but no one else will die sooner as a consequence!

Guest
Oct 11, 2011

When you write “jump the queue” what exactly are you prescribing? That Steve Jobs should have been arrested and prevented from flying to TN to have a liver transplant? We are bumping up against what is acceptable in a free society. One could retort that Mr. Jobs could have paid for everyone else’s surgery but I believe that there is a non-economic constraint here: Simply not enough livers to satisfy demand.

WRT to your conference in India, I am still waiting to be invited to deliver the keynote. Is the invitation in the mail?

Guest
Oct 11, 2011

It’s possible that the zen buddhist that Jobs was in an alternate life would have figured out that there was a spare liver going in Tennessee, and then asked who in the queue in California could have benefited from it most. If it was someone who’d been waiting longer, or someone who’s family needed them more than Jobs’ family (which was set for life anyway), the Zen Buddihst alternative Jobs would have made sure they got the liver….

but he did what any of us probably would have done–used his power to get what he thought was the best outcome for himself.

WRT India, you know we can’t afford your fees John, and it would be disrespectful to the free market to ask you for a discount

Admin
Oct 10, 2011

@Nancy:

“Sharon Begley, Newsweek’s ace science writer is just out with a piece suggesting that the aggressive and no doubt very costly care that Jobs received may have shortened his life rather than extending it. http://www.thedailybeast.com/articles/2011/10/05/steve-jobs-dies-his-unorthodox-treatment-for-neuroendocrine-cancer.html

I think she’s saying the opposite. We’ve actually been talking about this angle at THCB, But nice catch … / j

Guest
Alvaro Carrascal
Oct 10, 2011

Jobs, with a pancreatic cancer, got a liver transplant. Ok. How many people without health insurance get a pancreatic cancer diagnosed early enough, like Jobs, to live a couple of years more? Besides, who is to know that Jobs got to live two more years because of/despite of the care he got. Survival is not an exact science. Let’s be real. Don’t focus on exceptional cases like Steve Jobs, let’s look at the millions of John Does, every day cases, where health care is being rationed, not by bureaucrats but by the markets, because of lack of health insurance. Does the life of Steve Jobs is worth more than the life of John Doe?…

Guest
Oct 10, 2011

My late daughter might have survived with a liver transplant (she had Hep-B, and subsequent hepatoma; a new liver would have been clean of Hep-B). She was considered for it, but denied, ultimately. Insurance coverage had nothing to do with it directly (she was busted, and on Medi-Cal). It was based on survival potential and the likelihood of recurrence. Notwithstanding that it was her best shot, we all understood.

http://www.bgladd.com/1in3

Guest
Oct 10, 2011

As far as I know, you can also bought private health services in the U.K. In general, that is.

The real question is jumping the queue for organ transplants. While living organ transplantations are an option (in these, a third of the liver is usually transplanted from a living donor who will be just fine), the demand for cadaveric organs is high, as mentioned per the article/comments. Buying an organ transplant is in most cases considered unethical, so that would not be an option either. Which leaves us with jumping the queue?

I’m confused about what happened.

Guest
steve
Oct 10, 2011

The NHS has done pretty well with Stephen Hawking.

“However, it has been published far and wide that the U.K. has worse cancer care than the United States and much of Europe.”

A lot of that is artificial due to our treating cancers early that probably did not need treatment. Also, the UK spends half what we do for health care. They have chosen to keep costs down.

Steve

Guest
Oct 10, 2011

I don’t think anybody should second-guess what Mr. Jobs did or how he chose to approach his disease. It’s called “patient-centered” medicine and I thought that was were we are going with health care. Everybody should have the freedom to make these type of decisions, or am I mistaken?

On the organ transplant solution front, I feel uncomfortable with Mr. Goodman’s solution because someone like Mr. Jobs or Mr. Goodman himself would never be persuaded to donate organs unless they wanted to. Certainly not by a $15,000 offering. So we know where this is going, don’t we?
Here is a more equitable, albeit cruel solution (conservatives should love it). If you don’t sign your donor card at the DMV at least 5 years before you get sick, you don’t get an organ unless there is a surplus. Kids under 21 are exempt. People under 26 don’t need to have the full 5 years. People with mental disabilities and other diseases preventing donation are also exempt. People who refuse for religious reasons are not a problem, since that same religion should prevent them from accepting an organ.

Guest
DeterminedMD
Oct 10, 2011

Now you sound like a politician. When will party affiliation come into play!?

Guest
Oct 10, 2011

Never. Unless it’s the Green Back party, of course.

Guest
Oct 11, 2011

@Margalit Gur-Arie,

I don’t want to be on record as endorsing your proposal (about signing an organ-donor card) because I haven’t thought of the unintended consequences, but once again I am very impressed with your solution.

Guest
Oct 11, 2011

Thank you, John.
Either I’m slipping to the right, or the world can be made a better place… I think the latter.