Why such a strong emotional reaction to a boring factual statement? My conclusion, having read Hanson, was that people don’t want to think their health care system might let them die because it’s too expensive to keep them alive. They don’t like it any better when the government does it than when an insurer does — and so the government is at pains to suggest that cost is not a factor in their calculations. And I had made this remark at a time when those sorts of decisions were becoming more public, and more controversial.

Before the internet, most people had no way of knowing whether there were other treatments than the ones their doctors recommended, so as long as doctors only prescribed treatments that were approved, the government could maintain the fiction that there was no calculation going on.

America has never really had that comfort, because most doctors take a lot of different kind of insurance, and they don’t know what will be covered until after they’ve discussed treatment options. So Americans could hear about a treatment, find out it wasn’t covered, get outraged, and call their congressman. This may be one reason that our system is so expensive.

But it’s getting harder for everyone to conceal the calculations; information travels faster, and patients are better organized.