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Will Technology Save Us?

Ask most Americans what good health care means, and they're likely to say it's access to the latest medical technologies. Designer drugs, reconstructed body parts, exotic surgical techniques, sophisticated scanning and testing equipment, genetic engineering - we want it all, and we want it all now.

Most of all, we want someone else to pay for it.

In contrast to the common assumption that all this innovation is driving up the costs of medical services, some researchers argue that the quality-adjusted price of medical care is actually falling over time, as people stay healthier and continue to be productive well past the time when they used to drop dead from heart attacks, cancer and pneumonia.

Of course, a lower price on the social benefit-cost analysis side of the equation doesn't necessarily translate into a healthier bottom line for employers, providers and insurers. A long term profit to society is someone else's declining revenue stream or prohibitive capital investment. Whether we spend 14 percent or 25 percent of our GDP on health care, somebody has to pay the piper.

Meanwhile, rapacious marketing, the latest advocate group du jour, and imbalances in America's health care system conspire to mask the ambivalences and ambiguities in our love affair with medical technology.

For example, advertisers condition us to look for a technological fix for every medical problem., when it's often more cost effective to address the underlying problem itself. This is the guy with heart disease who thinks he can continue to eat cheeseburgers so long as he takes a Lipitor chaser. He could change his diet and exercise more, but where is the profit in that for the advertiser?

Or consider the case documented in an September/October 2001 Health Affairs article by Harvard researchers about the controversy of treating breast cancer with high doses of chemotherapy and autologous bone marrow transplants, coverage for which is high on the agenda of a well financed breast cancer lobby, but with clinical results that have gone "from guarded to bleak." Add expensive litigation by patients who were denied coverage, and it's not too surprising to see health plans add the treatment to their coverage, "notwithstanding doubts about its benefits."

Then there's what passes for the "logic" of America's health care system. In the same issue of Health Affairs, J.D. Kleinke outlines profit seekers in opposing corners of the marketplace: "Drug companies are rewarded for inducing demand for drugs, regardless of long-term economic value; insurers are rewarded for constraining that same demand, regardless of long-term economic value." This schizoid structure is repeated in public attitudes about access to pharmaceuticals: By all means we should let a free market of competing profit-seeking companies create the latest and greatest drugs, but then all of us - and especially those on Medicare and fixed incomes - should get these drugs on the cheap in a tightly regulated system.

Clearly we're moving from a health care system based on labor to one based on technology. It's not too different from the direction of the rest of the "new economy," and in the future we can presumably look forward to encounters with automated clinical diagnostic and prescription dispensing systems, brokered by "warm" facilitators and "high touch" encounters to remind us that we're still human after all.

But as we march forward into this brave new world, we should remember that although we might stay healthier longer, we won't stay healthy forever. There's an endgame in the social cost/benefit analysis of medical technology, and it comes when the cost of keeping someone alive is greater than the benefit of simply letting them live. A free market of high tech care works well for those with resources, but it leaves out millions of citizens with disabilities and chronic conditions who are unable to pay their way by themselves.

America will have health care rationing in any event. The issue is whether we have the political and moral will to do it with foresight and compassion, or whether we will continue to believe, as many do now, that science and the unfettered progress of the marketplace will save us.