Conservatives, Liberals, and Medical Progress

Whether one wants to call it a problem, a plague, or a pending crisis, it is clear that healthcare systems throughout the developed world are increasingly difficult to sustain. This is true whether they are market-dominated (as in the United States) or government-run and heavily regulated (as in Canada and Western Europe). In the U.S., tens of millions go without health insurance. Medicaid costs are giving the states economic fits, and the projections for Medicare over the next two decades are a well-publicized source of anxiety. In Canada, waiting lists plague the national healthcare system, and though patients are well covered for physician and hospital costs, they also pay a good bit out of their own pockets for other services. In Western Europe, the combination of lagging economies, high unemployment, and a citizenry unwilling to tolerate benefit cuts is giving administrators and legislators a chronic headache.

Yet even as healthcare costs continue to rise faster than inflation on both sides of the Atlantic, there is good reason to doubt that the actual health gains will be anywhere proportional to the cost escalation. Indeed, the recent history of health progress shows a significant divergence of costs and benefits: small health gains achieved at higher costs. Moreover, the fact that the rising cost problem afflicts all systems should undercut a common misconception afflicting both pro-government and pro-market advocates: that there is an organizational solution if only their respective ideological strategies were implemented. That may have been the case in the past, but it makes less and less sense in light of expensive medical advances and undiminished public demand for them. We increasingly want more healthcare than we can reasonably afford, and we are often unsatisfied with the healthcare we get.

Our predicament invites us to consider two fundamental but neglected problems: our unwavering national commitment to medical progress and the way medicine and the broader culture situate the place of death in human life. But haven’t these problems been discussed enough already — such as the high cost of medical care at the end of life or the role of technology in pushing up costs? I think not. The dilemmas of progress and the realities of death are commonly domesticated and often trivialized, turned into little more than troublesome management puzzles. We have lacked a serious and sustained consideration of the value of medical progress, beyond simply discussing how best to manage and pay for it. And we have approached death in the public square mainly with calls for new death-defying advances and greater patient choice at the end of life. Such responses are insufficient to the challenges ahead and the gravity of these subjects.

Unless we think more seriously about progress and death, there will never be a feasible, humanly tolerable way to organize and run a healthcare system. We need to begin with the present moment: Where are we now with the fruits of progress after a century of rapid development, and what are we to make of death now that so much has successfully been done to forestall it? In the political realm, neither liberals nor conservatives have grappled adequately with these questions, and yet both sides might have something constructive to offer, if only we could cut through the loud and divisive clashes of partisan politics.