I can say it because he didn't win $1 million and what he thought is meaningless. He won an annuity that will pay out $1 million over 20 equal annual payments. If there was a cash option it would be much less than $1 million. The rest of your rant suggests that you understand the concept.

If there was a cash option and he took it he would get the cash less tax withholdings. If he sells the annuty for its cash value and doesn't have taxes withheld he will have more money in his pocket until he has to pay taxes. That's the only way he's going to get the money he needs for the treatment he wants.

I agree 100% that there should be a cash option for all games.  If anything, it costs the state a few bucks more to administer the annuity, so I really don't understand what their reasoning is. Unfortunately, the game he played is annuity only and no amount of whining will change the fact that he voluntarily chose to play it anyway. If you don't like the deal you're offered the solution is to decline the offer, not take it and then whine about the bad deal you got. 

To me a lottery offering an annuity-only prize is a "lose-lose" situation. The player has one less choice, and the lottery ends up with overhead since the lottery has to keep track of the "winner's" address(es) for many years (and have a backup system in place,) and has to spend much more on postage, etc to such winners instead of sending a single payment. I wonder sometimes whether MA and/or NY, which between them have numerous annuity-only games, have personnel whose primary (if not sole) job is to deal with such "winners;" such employees would each cost the lotteries many thousands of dollars per year.

His medical treatment sounds sky high?  What is he paying that much money for?  I am sure the hospital is not giving him any real assurance that the treatment will save his life.  He should just take those money payments and perhaps the hospital can put him on a payment plan.. It's no use paying for treatments if you aren't around any longer, because the treatments faiil.  The VA hospital should be able to get up to speed for his care and maybe refer him to  the Eastern hospital for specialized procedures and then the VA would be responsible for paying the bill.

Considering that it's his money he should just be able to sell the annuity. There are plenty of firms that buy annuities. After taxes though it's way less than $400k. Most jackpot games only have an after tax payout in the 25 - 33% range.

If he wants the actual jackpot he'll have to try his luck in Canada or Europe.