Technology and ethics: three scenarios for the 1990s

The 1990s will be a critical decade for medical technology. An irresistible force (an aging population that requires more medical care) will meet an immovable object (limited resources). Technology will be the centerpiece of debates about the efficiency and efficacy of the health system in the United States, which currently has the best medical technology in the world and the highest medical costs, with much of the cost attributable to technology. Faced with the possibilities of maintaining our current health system, or going to other systems (Medical Break-throughs, Reregulation, or a National Health System), the United States needs a national health policy that cost-effectively raises health levels for all people. Technology can be the strong point of such a system. However, we must plan for and manage technology effectively. If managed care is unsuccessful in holding health inflation to below 10%, more radical solutions to the ethical issues involving the cost and availability of technology become increasingly necessary.