THE FUTURE OF HEALTH CARE: Two Books Offer Visions
In the current New England Journal of Medicine, Harvard Medical School's Dr. Arnold Relman reviews "two important new books that address the long-term future of medical care in the United States." The two books -- False Hopes: Why America's Quest for Perfect Health is a Recipe for Failure, by Daniel Callahan; and Life Without Disease: The Pursuit of Medical Utopia, by William Schwartz -- "provide us with thoughtful analyses of the problems" faced by the U.S. health care system, Relman writes, "but neither does more than suggest the broad outlines of a possible long-term solution."
In False Hopes, "respected bioethicist" Daniel Callahan argues that establishing a "sustainable medical care system" will require us "to rethink our notions of limitless and continuous progress in medicine." He says that a significant barrier to creating a better system "is an unrealistic faith in technology and overconfidence in the ability of medical science to eliminate illness and delay death." Callahan, Relman writes, "concludes that the market is more likely to increase spending and the use of technology than it is to control these forces." Overall, Callahan says Americans "must be willing to accept illness and death after our normal life span of 75 or 85 years has run its course." An improved health care system, he says, would focus on "the causes of premature death" by placing "a stronger orientation toward preventive medicine and public health."
A Sunnier Forecast
Though Schwartz shares Callahan's "premise that new technology is the root cause of the medical-cost explosion," Relman says Life Without Disease predicts that the problems that now confront the health care system will be solved in the next century following a wave of technological breakthroughs. While the system will get by in the short run "with rationing and other imperfect approaches," Schwartz "predicts that major technical and scientific advances will rescue our faltering health care system by eliminating most of the important causes of illness, extending our healthy life span by another 40 years or so and greatly reducing the need for medical services."
Relman concludes in his review of the two books: "As public and medical professional dissatisfaction with the present health care system mounts, I think it becomes increasingly unlikely that our country will be content to wait for either of the long-term solutions proposed in these books. ... Most citizens want a substantially improved health care system now, and I believe they will soon want to hear public discussion of proposals for achieving that end" (6/18 issue).