1. As was noted above, by the time this HSR begins operation, we will likely have self-driving transport. So there will be no loss of working time in taking a car versus a train.

2. This HSR will become immensely unpopular after it's first accident or terrorist attack. Using the kinetic energy of a fast train to kill and maim will prove too tempting a target for wacko terrorists, homegrown or overseas.

3. Who ever heard of basing ticket prices on what other transportation costs? This is a recipe for endless taxpayer subsidy. Ticket prices should be based on the operating costs and bond expenses. If we do this, this HSR will be prohibitively expensive.

4. California is different from Europe and Japan. Our *intra-city* public transport is not as nice, requiring the use of a car at one's destination (LA, SF).

5. Feelings towards this HSR project are not a litmus test for Democrat/Republican. It is a litmus test for those who pay heavy taxes and wish to see their money spend wisely, versus those who pay little in taxes and consequently are not as concerned how this money is spent.

Oops, I just checked. The average yearly cost of maintenance for a liver transplant may be as low as $20k/year (though a lot of info on google is in 1996 dollars - hard to know what the present value cost is).

For a couple of different reasons.

With this type of cutting edge medicine, people tend to have high expectations. In fact, what he is trading is a quicker death for a longer, lingering death. The longest I've heard an artificial heart working is about 500 days. Most of these hearts have to be replaced every 2 years at best. Repeat heart operations tend to be a bloody, high risk mess because of the scarring from the previous operation.

Secondly, this intensive type of treatment costs *a lot* of money. One has to wonder whether this money couldn't be better spent helping others with a better prognosis. If this young man is a private payer, then it's his decision to do with what he wishes with his money. If his healthcare is being paid for by others, isn't it their right to determine whether this is a justified expense? There are always opportunity costs.

Let me talk about an advanced procedure performed not infrequently in the US - a liver transplant. You first have the initial cost of the operation - about $500,000. Then you have yearly maintenance and monitoring, perhaps including biopsies to monitor rejection. Add another $200,000/year. Few people live a "normal" life after a liver transplant - by that I mean few people return to become productive members of society (however, there are a few who do).

At some point, one will conclude this money could be better spent on primary prevention, secondary prevention, or research.

PS: Ever wonder why school buses do not have seatbelts? It's because the cost per life-year saved is about $1 million. We *do* put a price on human life.

I wish I could feel better about this, but I don't. Most of these artificial hearts require systemic anticoagulation. Otherwise, they generate clots, which can travel to the brain and create a series of strokes, ultimately killing the patient.. Systemic anticoagulation brings it's own set of serious problems (bleeding tendencies, tissue changes, etc). My best wishes for this young man and his family.