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

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.

53 replies »

  1. This article is pathetic. America has the worst healthcare on the planet. And Steve Jobs travelled overseas to Sweden and other countries to receive treatments that would be illegal here in the so called “Land of hte Free” which is what many cancer patients do.

    On top of that, Canada and Britain both have higher life expectancies than the USA. I don’t think he would have lived longer in other countries, he’d have probably lived about the same age. The rich in America (such as him) have access to as much care as they need, had he been poor he would have died in 2003 when he originally got his cancer.

  2. The way I see it Barry, there are three groups involved: those who receive care, those who provide direct care and those who profit from care.
    Discounting for the variability in each group, I would say that people come first (the masses), providers (individuals) come second and profiteers have no room at the table.
    It is high time that people started protecting their piece of the pie, particularly since there’s not much left to protect. Those who lecture about Shared Sacrifice should understand that people have been involuntarily “sacrificing” for decades, and as much as the “powerful interests” may like to start fresh today, this is not acceptable.

  3. Margalit –

    I support all the changes I cited and I would like to see us tackle them as well. What I object to are individuals and interest groups that may support some changes but not any that would adversely affect them while others simply call for eliminating “waste” but have no real idea what that means or what it entails. As I’ve said before, I also support eliminating the tax preference for employer provided health insurance and lowering tax rates instead as well as the disclosure of actual contract reimbursement rates paid to providers. All of the various interest groups should get behind constructive changes including those that might adversely affect them in the short term. Trying to solve the problem at someone else’s expense while protecting one’s own piece of the pie won’t cut it.

  4. “Most of the changes you cited that could make the healthcare system require fundamental changes and most of those would be opposed by powerful interests that benefit from the status quo or are difficult for other reasons.”

    Yes. I agree. However, I would like to see us tackle the challenges and the powerful interests which are responsible for constraining our resources, instead of adding insult to injury by making these constraints sound like immutable laws of nature. They are not.

  5. Margalit –

    Most of the changes you cited that could make the healthcare system require fundamental changes and most of those would be opposed by powerful interests that benefit from the status quo or are difficult for other reasons. For example:

    1. Just about everyone thinks we should move away from the fee for service payment model which rewards volume in favor of bundled payments or capitation that rewards quality and value. Quality and value, though, have to be defined and they have to be measurable and we have to mitigate the incentive to withhold needed and necessary care. That’s all easier said than done.

    2. Empowering patients are fine but many patients, and perhaps a majority, will continue to be passive and just go along with whatever their doctor recommends. Many doctors, for their part, bristle at anyone, including patients questioning or getting in the way of their decision making.

    3. If we want to reduce unnecessary diagnostic testing, we need to provide doctors with robust safe harbor protection from failure to diagnose lawsuits if they follow evidence based guidelines where they exist. Trial lawyer will oppose this and most liberal democrats support trial lawyers because they raise and contribute a lot of money to political campaigns.

    4. We could probably mitigate fraud with robust ID cards for anyone with the authority to bill Medicare and/or Medicaid and make the full Medicare claims database available to outside analytics firms. Neither idea has gained any traction so far.

    5. We could push back against very high cost specialty drugs by refusing to put them on the formulary and pay for them. There hasn’t been much appetite for that yet at CMS or in Congress either.

    6. We could save money on end of life care if many more people executed living wills and advance directives and we stored the information on a registry so it’s available to doctors and hospitals when needed. When there are no documents and nobody to speak for the patient if he can’t, we could change the default protocol from do everything to apply common sense depending on circumstances but doctors and hospitals, again, would need strong protection from lawsuits to move in that direction. Doctors treating patients at the end of life also need to embrace palliative care as an option whereas many don’t today.

    7. More widespread use of tiered networks and limited networks could steer more patients toward the most cost-effective high quality providers. That concept is starting to gain more traction with employers but it’s still early.

    So, we can’t just wave a magic wand and implore both patients and providers to cut out the waste in the system. We need fundamental structural changes, including in the litigation system, to have a chance of making it happen. In the meantime, the waste will continue and money will remain the constraining resource.

  6. Mortality is the issue with cancer care. No one wants to die. Patients are willing to try anything to extend there life even if that means expensive surgery and drugs. Its a hard thing to say one or two extra months is not worth paying for or youre old and you had a good life. And yes, patients that opt for plliative care may live longer but they also have resigned to the fact that they will pass from there disease. Patients that opt for treatment have a chance for cure. Again back to the mortality issue…round and round we go

  7. Here is my problem with this, and I do understand that money is finite.

    We keep saying that if we educate, explain and empower patients to make their own decisions, they will choose less invasive and less heroic care, less hospitalizations, less medications, less harmful tests and procedures and more palliative and watchful waiting things. And generally speaking, less care is better care. If this is true, empowered patients will surely pick the cheap stuff, no?
    We are also saying that medicine is full of errors, unwarranted variability and all sorts of fraud. These are addressable issues.
    And then we say that unit costs are inexplicably high for hospitals, drugs and specialty care, which are also things that we should be able to address.
    Some of us also argue that various stakeholders not engaged in direct care are extracting a bit too much profit from the system, while contributing handsomely to administrative complexity, This too could be at least partially addressed.

    Assuming that we really mean what we say, and we really believe that all the above holds true (except the last item perhaps), it is not fair to load up the system with so much waste, disregard patient choices, and argue that we cannot afford to do something that has not been tried before.

    I also understand that taking things away from little people is the easiest path these days, and while money is finite, greed does not seem to have such limitations.

  8. “Also, how do “we know we can’t possibly afford to give everyone everything they or their families might want”, when we never really tried it?”

    Margalit –

    To paraphrase former tennis great, John McEnroe, you can’t be serious. What do you think would happen to costs (and taxes) if Medicare decided to try the following:

    1. Eliminate all deductibles and co-pays for hospitalizations, Part B services and prescription drugs.

    2. Pay for all routine dental and vision care which is not covered today.

    3. Pay for an unlimited number of days in the hospital as well as an unlimited number of home healthcare visits.

    4. Pay in full for all custodial long term care in skilled nursing facilities or assisted living centers.

    5. Pay for any experimental drug or operation that a patient might want to try.

    CMS, Medicaid and all other insurers limit what they will cover and pay for because it’s unaffordable to do otherwise even at CMS’ relatively low dictated prices. Money is the constraining resource, a given dollar can only be spent one time and there are plenty of other legitimate needs besides healthcare. Resources are finite plain and simple. It’s not rocket science.

  9. 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

  10. @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.

  11. 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?

  12. 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!

  13. The $2.2 Trillion dollar high tech-high- cost enterprise of medicine works great for the rich among us in the US. It is abysssmally failing for many who cannot even afford the basics or who lack any health isurance coverage.

    The US has no peer in “Medicine” but we are a global embarrassment when it comes to “Health” “Health verses Medicine”- think about that framing.

  14. I really hope someone else will challenge this commenter on her interpretation of availability of goods and services in the health care industry. Maybe if such person can frame it differently than I tried, it may make sense?

  15. Rewrite on the tile should be” Thank the US Entrepreneurship Spirit for the Life of Steve Jobs”. What Steve Jobs created in his garage and the creation of Apple is what kept him alive. His “Entrepreneurship Spirit” would not have been encouraged or survived in other parts of the world.

  16. The article offers a false comparison. Steve Jobs was wealthy enough to have obtained any sort of health care he needed regardless of where he lived and what system his country had.

    If he had been poor and in the US, he would have died many, many years ago.

    The genius that allowed him to create Apple, Pixar and some many great products also gave him the wealth to make a comparison with his access to health care and the average person meaningless.

  17. Here we go again: “a real world of finite resources”
    Barry, please read (or skim through) the previous Goodman post below.

    What “resources” might those be that are finite or scarce, as the real Peter puts it?
    The only thing that is scarce is the money to pay for resources, and obviously it is scarcer for some more so than the others.

    Also, how do “we know we can’t possibly afford to give everyone everything they or their families might want”, when we never really tried it?

  18. Peter 1 –

    Not all healthcare resources are scarce. Some are very expensive for the benefit they provide like some high priced cancer drugs. It would be reasonable for insurers, including Medicare, to not cover some of those based on QALY metrics but wealthy people could still buy them with their own funds if they wanted to.

    I don’t think organ transplants are allocated on a first come first served basis as you say. Some people may need a kidney transplant but are not considered viable candidates because of age or other factors. A younger person should probably have a chance at one before a much older person. There are elaborate protocols, I think, that are used to determine who even gets on the list and how organs get allocated by geographic region. Steve Jobs found his way to Tennessee for a liver transplant, presumably, because it happened to have a shorter waiting list. Others have been known to go overseas for kidney transplants were buying and selling organs is a permitted practice.

    As for the poor and uninsured, I recall Bill Frist, the former senator and a heart transplant surgeon once told an interviewer that he did about 150 heart transplants during his medical career to that point. Roughly half of those went to Medicaid patients. That said, at the population level, poor people don’t live as long as middle class and wealthy people for a number of reasons of which lack of access to good care when needed is just one.

  19. Barry, if you believe all healthcare resources are scarce then they are just that, scarce, and not for sale to the highest bidder, but allocated on the “Qaly Metrics” of the system. Do you believe that “rich” people should get the transplant they can pay for over those available on a first come first serve basis of even insured/uninsured? The Mickey Mantle allocation?

  20. Wealthy people like Steve Jobs should be free to use their own money to buy any healthcare service, test, procedure or drug that they think might help them. If they need to go outside the country to do so, that’s fine too. For the rest of us who rely on taxpayers and private insurers to pay for most of our healthcare, realistic limits need to be set somehow in a real world of finite resources. As a recent NY Times letter to the editor writer asked (paraphrasing): Should taxpayers be expected to pay $1 billion for one extra day of life just because the patient or the family wants it? I don’t think so. QALY metrics are one way to set these limits. Age based rationing is another and I’m sure there are others. The issue isn’t who favors rationing and who doesn’t. It’s about setting limits fairly and responsibly when we know we can’t possibly afford to give everyone everything they or their families might want no matter how small the benefit or how high the cost.

    With respect to the shortage of organs available for transplant, perhaps making people organ donors should be the default choice unless they affirmatively sign appropriate documents indicating that they don’t want to be. Such an approach would increase the supply of organs and would also add to healthcare costs as well but that’s a separate issue.

  21. I agree with Mr. Goodman that Jobs’ case raises a number of issues, not only regarding potential organ recipients, but also about the disparities that exist in America related to the availability of affordable, quality, and equitable health care to all American citizens. When considering Mr. Jobs’ initial diagnosis of and surgery for pancreatic cancer and then his liver transplant several years later, I cannot help but wonder how his health care options as a wealthy, influential entrepreneur were different than if he had been an uninsured patient or even an insured individual from a different (lower) socioeconomic class.

    Health care rationing in various forms has been a part of the United States healthcare system for many years. One example is access to health care insurance being rationed based on cost and ability to pay the high premium rates. A second example relates to the insurance industry’s practice of excluding people with preexisting conditions, although this procedure will end in 2014 thanks to the Affordable Care Act. As difficult as it is, there must be a procedure in place to ensure available resources are being spent on the most appropriate care. I am unsure whether or not the QALY is the best option to determine cost-effective expenditures, but several countries besides Britain use this method to help control health care costs.

    The unfortunate reality of the situation is that health disparities continue to exist, millions of Americans remain uninsured or underinsured, and health care costs remain out of control. This article sheds light on several challenges that continue to plague the US health care system.

  22. As usual the efficacy of medical treatments is being conflated with where the money comes from.

    Unless and until these two realities get untangled discussions such as this will never end.

    ==>Treatment options run from homeopathy to the latest in scientific discoveries and medical/surgical discoveries, with a wide range of options in-between.

    ==>Payment options run from charity to the deepest of private-pay pockets, with tax money, insurance plans (with or without deductibles) and research grants in-between.

    Medical needs present from all parts of the income spectrum and providers decide how, when and which of them are addressed.
    Some ask no questions.
    Others want to know in advance whose name will be on the check.

    Anyone who thinks the public relations value of treating a high-profile figure (political, entertainment, sports, business, etc.) is not among the variables is living in a fool’s paradise.

    Ascribing medical outcomes to national policy issues makes as much sense as attributing sunrises to the crowing of roosters.

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

  24. It was a joke regarding that totally crazy lawyer/dentist/real estate agent Orly Taitz. The Birther-in-Chief. (“Birffer”)


  25. Amen, and whatever common ground does do the public benefit, let’s hope it is felt and appreciated!

    By the way, “Birff Certificate”?

  26. “Hey, I truly mean this when I say this, I hope I am wrong, because often when I am wrong I am happy.”



    It was an epiphany for me.

    “To err is human. Yet most of us go through life tacitly assuming (and sometimes noisily insisting) that we are right about nearly everything, from the origins of the universe to how to load the dishwasher. If being wrong is so natural, why are we all so bad at imagining that our beliefs could be mistaken – and why do we typically react to our errors with surprise, denial, defensiveness and shame?”

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

  28. So, should PPACA survive and we see even greater limits on procedures like organ transplants, and then find out politicians or their crony buddies in the financial oligarchy gain easy and quick access to survive and thrive, how long before the mobs that are calm in New York now will be raging with pitchforks and torches?

    Think that scenario absurd? The movie “John Q” certainly did not seem outlandish to me. When you watch your child die and then read or see about some well to do rich guy or his over protected child get the care, you think the response will be “oh well”. Yeah, it is so easy to envision that future.

    By the way, Mr G, we may have our differences, but I sincerely offer my past due condolences to your daughter’s passing. Losing a child is very difficult, so I hope you have handled the grief as best able. The way you note it here is admirable.

    I still am passionate and resolved to attack and thwart the efforts of PPACA surviving through 2012. It will be the final assault on what little is left in responsible and ethical options for physicians to treat patients. And, the use of computer technology will be the insidious means to our ends.

    Hey, I truly mean this when I say this, I hope I am wrong, because often when I am wrong I am happy. I wish I could say I am wrong often though.

  29. 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.

  30. 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.


  31. 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.


  32. 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.

  33. 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?…

  34. 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”?

  35. @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?

  36. 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.

  37. Note: A shorter version of this original post was re-published here. The post now appears in its entirety. Apologies for the omission.

  38. 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.

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

  40. 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.

  41. 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..

  42. “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.