Life without Disease: The Pursuit of Medical Utopia

Overview


The chaotic state of today's health care is the result of an explosion of effective medical technologies. Rising costs will continue to trouble U.S. health care in the coming decades, but new molecular strategies may eventually contain costs. As life expectancy is dramatically extended by molecular medicine, a growing population of the aged will bring new problems. In the next fifty years genetic intervention will shift the focus of medicine in the United States from repairing the ravages of disease to ...
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Overview


The chaotic state of today's health care is the result of an explosion of effective medical technologies. Rising costs will continue to trouble U.S. health care in the coming decades, but new molecular strategies may eventually contain costs. As life expectancy is dramatically extended by molecular medicine, a growing population of the aged will bring new problems. In the next fifty years genetic intervention will shift the focus of medicine in the United States from repairing the ravages of disease to preventing the onset of disease. Understanding the role of genes in human health, says Dr. William B. Schwartz, is the driving force that will change the direction of medical care, and the age-old dream of life without disease may come close to realization by the middle of the next century. Medical care in 2050 will be vastly more effective, Schwartz maintains, and it may also be less expensive than the resource-intensive procedures such as coronary bypass surgery that medicine relies on today.
Schwartz's alluring prospect of a medical utopia raises urgent questions, however. What are the scientific and public policy obstacles that must be overcome if such a goal is to become a reality? Restrictions on access imposed by managed care plans, the corporatization of charitable health care institutions, the increasing numbers of citizens without health insurance, the problems with malpractice insurance, and the threatened Medicare bankruptcy--all are the legacy of medicine's great progress in mastering the human body and society's inability to assimilate that mastery into existing economic, ethical, and legal structures. And if the average American life span is 130 years, a genuine possibility by 2050, what social and economic problems will result?
Schwartz examines the forces that have brought us to the current health care state and shows how those same forces will exert themselves in the decades ahead. Focusing on the inextricable link between scientific progress and health policy, he encourages a careful examination of these two forces in order to determine the kind of medical utopia that awaits us. The decisions we make will affect not only our own care, but also the system of care we bequeath to our children.
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Editorial Reviews

Journal of the American Medical Association
Life Without Disease is an easy and interesting guide to the background and evolution of medical therapy and health care delivery, with an extrapolation to the future. I recommend it to anyone concerned with health policy and also to practicing doctors who, immersed in patient care, had better take the time to learn where they fit in the scheme of things.
Kirkus Reviews
A physician grounded in economics, ethics, and public policy sheds light on medical care issues by examining how the recent past has shaped the present and what the future is likely to offer. Schwartz, a professor of medicine at the University of Southern California and a former advisor to the Rand Corporation on health policy, divides his analysis into three parts: a look back over the last 50 years to the beginnings of the modern health- care industry; a short-range forecast for the years 2000 to 2020, and a longer-range one to the year 2050. He chronicles the trends of the past half century: the enormous advances in medical technology that followed the federal government's funding of biomedical research, the revolution in health insurance, the public's perception of health care as a right, and the current concerns over spiraling costs and the threat of health-care rationing. In the near future, he sees a continuation of current trendsþfewer and larger providers, a growing corporate role in health-care delivery, and great advances in bioengineering and molecular medicine. While their initial value has been limited primarily to diagnosis and genetic screening, Schwartz spells out how in the coming decades these will lead to powerful tools for treating disease and repairing its consequences. He examines what these new and expensive high-tech therapies will offer and how they will clash with health-care cost-containment efforts, and he proposes comparing the per dollar cost of expected benefits as a method of resource allocation. By the year 2050, Schwartz predicts, molecular medicine and improvements in diet and the environment may have brought us to the threshold of avirtually disease-free world in which health-care costs would likely plateau or even fall. However, he cautions, the resulting dramatic increase in life expectancy will create new ethical and social problems requiring careful thought. A provocative analysis of the challenges facing makers of health-care policy.
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Product Details

  • ISBN-13: 9780520221734
  • Publisher: University of California Press
  • Publication date: 1/14/2000
  • Edition number: 1
  • Pages: 190
  • Product dimensions: 5.63 (w) x 8.75 (h) x 0.50 (d)

Meet the Author

William B. Schwartz, M.D., is a Professor of Medicine at the University of Southern California and a Fellow at the Pacific Center for Health Policy and Ethics. He was formerly Chairman of the Department of Medicine at Tufts University Medical School and advisor on health policy to the Rand Corporation. He is coauthor of The Painful Prescription: Rationing Hospital Care (1984).

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Table of Contents

Preface
Prologue: The Dream of a Medical Utopia 1
Pt. I Halfway to Utopia: 1950 to 2000 5
1 The Birth and Growth of Big Medicine 7
2 Failed Attempts at Sustained Cost Control 31
3 Reorganization of the Health Care Delivery System 49
Pt. II Utopian Promise and Real-World Problems at the Dawn of the Twenty-First Century 61
4 Medical Progress in the Near Term: 2000 to 2020 65
5 Health Care Rationing: The British Experience 81
6 Managed Care and Rationing in the United States 89
7 A Strategy for More Equitable Rationing 104
8 Cost Containment and the Courts 114
Pt. III Molecular Medicine Comes into Its Own: 2020 and Beyond 123
9 Molecular Medicine: A New Era of Therapy 127
10 On the Threshold of Utopia: Approaching 2050 149
Epilogue 157
Notes 161
Index 173
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