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

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

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

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


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?

In Taming 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 Beast shows 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.


This book was completed in the midst of one of the great fiscal crises of American economic history. It is still too early to know what the long-term implications and fallout will be and what it may mean for American health care in particular. How much and what kind of health care reform under a new president and Congress will be possible is now up in the air. The general economic woes surely pushed health care off the front page for a time, and even the presidential candidates had to put it aside for a spell.

Public opinion polls showed a remarkable fluctuation in 2007–2008. For a time they showed that the public saw health care reform, and cost control especially, as a top priority, even more than ending the Iraq war. But by late 2008 it had declined in importance, overshadowed by the larger economic travail. Meanwhile a steady stream of new studies showed the health care system deteriorating: the number of uninsured and underinsured steadily grew, costs continued to rise, employers slowly but steadily cut health care benefits altogether or cut their scope and coverage, out-of-pocket medical expenses continued to rise, and even the reasonably well insured reported financial distress from medical bills.

It was in one sense exhilarating to be writing a book on health care reform at a time when it had become a major domestic issue, even if that status fluctuated from time to time. But it was also distressing. We have a messy system, one ill-designed for reform because of the accretion of assorted interest groups with different agendas and vested interests, an ideologically divided public, and a steady stream of new and expensive technologies added to those already in place. If it is not too difficult to envision an ideal system, and there are many to choose from, it is more difficult to imagine politically just what it will take to put such a system in place. It is hardly less difficult to think of a fully defensible way of dealing with the main ethical dilemma that underlies the management of technology and health care costs: how to persuade the public and . . .

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