OP-ED

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.

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JustinWayneBrianDr. Rick LippinMiamiBeach Recent comment authors
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Justin
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Justin

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… Read more »

John Ballard
Guest

Shhh…
Listen…

I think I hear the crowing of another rooster.

Wayne
Guest

Again an article about the genious of technology. Praising Jobs is getting old.

Barry Carol
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Barry Carol

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… Read more »

Margalit Gur-Arie
Guest

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… Read more »

Barry Carol
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Barry Carol

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… Read more »

Margalit Gur-Arie
Guest

“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.

Brian
Guest
Brian

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… Read more »

Barry Carol
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Barry Carol

“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… Read more »

Margalit Gur-Arie
Guest

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… Read more »

Dr. Rick Lippin
Guest

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.

BobbyG
Guest

Thank you.

MiamiBeach
Guest
MiamiBeach

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.

Jim S
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Jim S

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.

Margalit Gur-Arie
Guest

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?

DeterminedMD
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DeterminedMD

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?

Barry Carol
Guest
Barry Carol

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… Read more »

Peter1
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Peter1

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?

Barry Carol
Guest
Barry Carol

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… Read more »

SheliaS
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SheliaS

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… Read more »

John Ballard
Guest

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… Read more »