Healthy, Wealthy, or Wise? Issues in American Health Care Policy

By Charles T. Stewart Jr. | Go to book overview

special skills and want to put them to use. They are more interested in the process perhaps than in the product. This was stressed in their apprenticeship as interns and residents. In this country the special skills in which one takes great pride are not the traditional crafts carried on from generation to generation but the newest skills, never before known; the latest, therefore in American mythology, the best. The customer agrees, he or she wants the latest technology available in a technocratic civilization. Both M.D. and customer are ever on the lookout for new technology, the final product of the industry of discovery and invention that is research and development: "the underlying bias of the technological mindset and its activity orientation . . . that newer must be better and that doing more must be better than doing less; hence the possibility of harm is always a second thought. . . ." 17

Health care has been dominated by the technological imperative--the belief that new drugs, new procedures, new treatment will cure nearly all disease, including the failures of will and character. This belief is most likely to prevail in teaching hospitals, and is independent of method of compensation. It caters to a desire to learn and a desire to play with new technological toys. If a patient were aware of the risks and uncertainties involved in new drugs and new procedures, he or she might opt against them. But, then, the M.D. may not know either.


Notes
1.
Rick J. Carlson, The End of Medicine ( New York: Wiley, 1975).
2.
"Perestroika for Bones," Economist, June 25, 1988, 87-88.
3.
Thomas Moore, Lifespan--Who Lives Longer and Why ( New York: Simon and Schuster, 1993), 144-46.
4.
Gina Kolata, "Obesity Declared a Disease," Science 227 ( March 1, 1985): 1019-20.
5.
Deborah Barnes, "Neurotoxicity Creates Regulatory Dilemma," Science 243 ( January 6, 1989): 29-30.
6.
Murray E. Jarvik, "The Drug Dilemma: Manipulating the Demand," Science 250 ( October 19, 1990): 387-92.
7.
Daniel Callahan, What Kind of Life--the Limits of Medical Progress ( New York: Simon and Schuster, 1990), 208.
8.
Victoria Conti, "New Insights into Cancer, Psoriasis, and Other Major Health Problems," NCCR Reporter, March/April 1994, 4-11.
9.
Steve Olson, Biotechnology--an Industry Comes of Age ( Washington, D.C.: National Academy Press, 1986).
10.
Yoshio Miki, Jeff Swensen, Donna Shattuck-Eidens, et al., "A Strong Candidate for the Breast and Ovarian Cancer Susceptibility Gene BRCA1," Science 266 ( October 7, 1994): 66-71; and Richard Wooster et al., "Localization of a Breast Cancer Susceptibility Gene, BRCA2, to Chromosome 13q12-13," Science 265 ( September 30, 1994): 2088-90.
11.
Rachel Nowak, "Genetic Testing Set for Takeoff," Science 265 ( July 22, 1994): 464-67, esp. 467.

-97-

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Healthy, Wealthy, or Wise? Issues in American Health Care Policy
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Notes viii
  • 1 - Determinants of Health 1
  • Notes 6
  • 2 - Why Are Costs Out of Control? 7
  • Notes 27
  • 3 - Must Living Standards Decline? 28
  • Notes 38
  • 4 - Health Insurance Raises Demand and Supply 40
  • Notes 49
  • 5 - The Excess of Physicians and Services 51
  • Notes 77
  • 6 - The Medicalization of Health 82
  • Notes 97
  • 7 - Mental Illness 99
  • Notes 119
  • 8 - The Excessive Demand for Medical Care 123
  • Notes 136
  • 9 - Research and Technology 138
  • Notes 161
  • 10 - The Physician as Agent 164
  • Notes 179
  • 11 - Prevention: Environmental and Behavioral Modification 181
  • Notes 210
  • 12 - The Demedicalization of Health Care 213
  • Notes 222
  • 13 - What to Do? 223
  • Notes 250
  • Index 253
  • About the Author 263
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