LIFE WITHOUT DISEASE

A physician grounded in economics, ethics, and public policy sheds light on medical care issues by examining how the recent past has shaped the present and what the future is likely to offer. Schwartz, a professor of medicine at the University of Southern California and a former advisor to the Rand Corporation on health policy, divides his analysis into three parts: a look back over the last 50 years to the beginnings of the modern health- care industry; a short-range forecast for the years 2000 to 2020, and a longer-range one to the year 2050. He chronicles the trends of the past half century: the enormous advances in medical technology that followed the federal government’s funding of biomedical research, the revolution in health insurance, the public’s perception of health care as a right, and the current concerns over spiraling costs and the threat of health-care rationing. In the near future, he sees a continuation of current trends—fewer and larger providers, a growing corporate role in health-care delivery, and great advances in bioengineering and molecular medicine. While their initial value has been limited primarily to diagnosis and genetic screening, Schwartz spells out how in the coming decades these will lead to powerful tools for treating disease and repairing its consequences. He examines what these new and expensive high-tech therapies will offer and how they will clash with health-care cost-containment efforts, and he proposes comparing the per dollar cost of expected benefits as a method of resource allocation. By the year 2050, Schwartz predicts, molecular medicine and improvements in diet and the environment may have brought us to the threshold of a virtually disease-free world in which health-care costs would likely plateau or even fall. However, he cautions, the resulting dramatic increase in life expectancy will create new ethical and social problems requiring careful thought. A provocative analysis of the challenges facing makers of health-care policy.