A call to revolution

Americans will not succeed in containing healthcare costs until they make some radical changes in the way they think about life, death, and the pursuit of good health. This is the contention of Daniel Callahan, who, in his new book, What Kind of Life: The Limits of Medical Progress, calls for a revolution of sorts-a change in the nation's psychological and political foundations. In Callahan's brave new world, limits rather than aspirations, risks rather than benefits, and pitfalls rather than opportunities would be emphasized. Research projects with costly and likely limited social payoffs would be rare; Americans, accustomed to demanding the most advanced technology that medicine has to offer, would have to accept the inevitability of disease and death. Callahan presents an outline for establishing healthcare priorities and rationing services. He frames those priorities within a context of limits on extending longevity and pursuing individual cures. The outline is pyramidal. Fewer people generally would receive health services as they ascend the pyramid's six levels, and the cost per person would rise dramatically. In this milieu, children would have "some priority" over adults, particularly the elderly.