Life without Disease

The Pursuit of Medical Utopia

William B. Schwartz M.D.

• Publisher: University of California Press
• Year: 2023
• ISBN:
  9780520335578
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

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. This title is part of UC Press's Voices Revived program, which commemorates University of California Press's mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1998.

Table of contents

• Cover
• Title
• Copyright
• Contents
• Preface
• Prologue The Dream of a Medical Utopia
• Part One Halfway to Utopia 1950 to 2000
• 1 The Birth and Growth of Big Medicine
• 2 Failed Attempts at Sustained Cost Control
• 3 Reorganization of the Health Care Delivery System
• Part Two Utopian Promise and Real-World Problems at the Dawn of the Twenty-First Century
• 4 Medical Progress in the Near Term: 2000 to 2020
• 5 Health Care Rationing: The British Experience
• 6 Managed Care and Rationing in the United States
• 7 A Strategy for More Equitable Rationing
• Part Three Molecular Medicine Comes into Its Own 2020 and Beyond
• 9 Molecular Medicine: A New Era of Therapy
• 10 On the Threshold of Utopia: Approaching 2050
• Epilogue
• Notes
• Index