Taming the Beloved Beast

Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System

Daniel Callahan
Copyright Date: 2009
Pages: 288
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  • Book Info
    Taming the Beloved Beast
    Book Description:

    Technological innovation is deeply woven into the fabric of American culture, and is no less a basic feature of American health care. Medical technology saves lives and relieves suffering, and is enormously popular with the public, profitable for doctors, and a source of great wealth for industry. Yet its costs are rising at a dangerously unsustainable rate. The control of technology costs poses a terrible ethical and policy dilemma. How can we deny people what they may need to live and flourish? Yet is it not also harmful to let rising costs strangle our health care system, eventually harming everyone?

    InTaming the Beloved Beast, esteemed medical ethicist Daniel Callahan confronts this dilemma head-on. He argues that we can't escape it by organizational changes alone. Nothing less than a fundamental transformation of our thinking about health care is needed to achieve lasting and economically sustainable reform. The technology bubble, he contends, is beginning to burst.

    Callahan weighs the ethical arguments for and against limiting the use of medical technologies, and he argues that reining in health care costs requires us to change entrenched values about progress and technological innovation.Taming the Beloved Beastshows that the cost crisis is as great as that of the uninsured. Only a government-regulated universal health care system can offer the hope of managing technology and making it affordable for all.

    eISBN: 978-1-4008-3094-7
    Subjects: Political Science, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xii)
    (pp. 1-9)

    Once again the United States is in the midst of a periodic health care “crisis,” one that has emerged about every 15 years since World War II. Once again talk of reform is in the air. Once again public opinion polls show, as they have done for decades, that a strong majority of Americans want universal health care—and also how divided they are about how to get there. Once again the complexity of reform, competing interest groups, and the long-standing resistance to an expanded role for government stand in the way.

    Is it different this time? Will reform elude...

    (pp. 10-36)

    Few government programs have been as popular as Medicare. Its reputation is a triumph in a country prone to think poorly of government and of the regulations, waste, and bureaucracy widely believed to be its bastard child. It is hardly a perfect program, yet it has endured for over 45 years, and, save for some strong market advocates, only a few propose that it should be significantly changed, much less abolished.

    Yet along with American health care more generally, Medicare is coming into increasingly difficult, even threatening, times. The health care system, of which Medicare is a key part, is...

  6. Chapter 2 TAMING THE BELOVED BEAST: Medical Technology
    (pp. 37-66)

    I have likened medical technology to an unruly and untamed, but beloved, beast: it saves and improves our lives with its undoubted power to diagnose and treat but, in its unrestrained lumbering about in the house of medicine, increasingly wreaks financial havoc. Is “havoc” too strong a word to use? Recall the figures presented in the previous chapter: a projected increase in the Medicare spending from $427 billion in 2006 to $884 billion in 2030. For the health care system as a whole, the figures move from $2.6 trillion in 2006 to $4.1 trillion in 2015.

    That kind of increase...

    (pp. 67-91)

    To use a boxing analogy, most of the actual and proposed means of controlling costs amount to feinting, dancing, jabbing at the problem, not striking with any force. They sound good, and some would surely be helpful, but most of them tend to be general and vague, and some exhibit a paralyzing fear of bursting the technology innovation bubble: “more, just more.” Are they the best we can do—or are willing to do?

    That last question brings to mind another old boxing expression used when, somehow, the whole match looks fishy: is it possible that “the fix is in”?...

  8. Chapter 4 COMPETITION: The Fix That Will Fail
    (pp. 92-119)

    With the advent in 2009 of a new president and Congress, health care reform will obviously be a leading issue. A number of reform proposals have already been advanced, ranging from single-payer plans to those with a varying mix of government and market strategies. The role of competition in health stands squarely in the middle of the debate, cited in a variety of the proposals. A number of economists, political conservatives, and many from the business community have had a long-standing affection for competition; and it is now a key ingredient of CDHC.

    In its production and distribution of many...

    (pp. 120-142)

    Earlier chapters in this book could well have given the impression that technology is somehow an independent actor with a life of its own. This is not so, even though the cultural force of a commitment to technological innovation is an important part of the story. Technology costs are determined by those who invent it, prescribe it, and consume it, and the relationship between medicine and industry is the central part of that combination.

    If a love of medical technology is deeply rooted in an American culture long enamored of all forms of technology, a love of commerce is easily...

  10. Chapter 6 “MEDICAL NECESSITY”: An All-But-Useless Concept
    (pp. 143-170)

    The United States, it is often said, has no real health care system, at least if that means a centrally organized system with an integrated set of institutions and practices.

    As a general characterization, that statement is true enough. But our hybrid arrangements, mixing private and public values and organizing principles, do have a deep-seated set of cultural values, reflecting a long history of tension and struggle. The principal values are choice and individualism, but with an important qualification, that of the necessity of government to support care for the poor and the elderly. But even the latter has in...

  11. Chapter 7 REDEFINING “MEDICAL NECESSITY”: From Individual Good to Social Good
    (pp. 171-200)

    “Medical necessity” has not worked well in practice as a standard of care for individuals and is all but useless in dealing with costly technologies. The concept runs up against three confounding elements. One of these is the force of medicalization, which over time turns many desires into felt needs, particularly as medical progress finds ways to treat undesirable pathological conditions that were earlier simply taken to be an unavoidable part of life. Another is that of using medical means to deal with problems that are not inherently medical at all but are amenable to medical solutions (the contraceptive pill...

  12. Chapter 8 GETTING OUT FROM UNDER: The Politics of Pain
    (pp. 201-228)

    Cost control and particularly the management of technology will be painful, necessarily so. It will mean giving up some benefits long taken for granted. It will mean saying no on many occasions to doctors, to patients, to health care administrators, and to industry. It will mean trying to justify what will seem patently unacceptable: your expensive care may be good for you but harmful to the rest of us. It will mean saying that a marginal benefit will not be covered by private insurance or Medicare, while at the same time conceding that “marginal” is not the same as “useless”;...

  13. CODA
    (pp. 229-234)

    Every author should be allowed at least once in a book to nakedly display his feelings, usually hidden beneath the veneer of scholarly distance and hints of gravitas. He should be allowed at least one tantrum, one fit of confused hysteria, one instance of teeth-gnashing, one outburst of political exasperation, and in this case more than one bout of moral anguish.

    My tantrum first came one day when I realized that there are many of my fellow citizens, and even a few health care professionals, who seem unwilling to accept any stance toward cost control that does not deliver a...

  14. NOTES
    (pp. 235-256)
  15. INDEX
    (pp. 257-267)