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. In fact, 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 because of the shortage of donated organs.
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.
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.
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.