Preface ix
Introduction 1
CHAPter 1: Medicare on the Ropes 10
CHAPter 2: Taming the Beloved Beast: Medical Technology 37
CHAPter 3: Getting Serious about Costs and Technology 67
CHAPter 4: Competition: The Fix That Will Fail 92
CHAPter 5: The Cohabitation of Medicine and Commerce 120
CHAPter 6: "Medical Necessity": An All-But-Useless Concept 143
CHAPter 7: Redefining "Medical Necessity": From Individual Good to Common Good 171
CHAPter 8: Getting Out from Under: The Politics of Pain 201
Coda 229
Notes 235
Index 257

Why health care reform must tackle the escalating cost of medical technology
Technological innovation is deeply woven into the fabric of American culture, and is no less a basic feature of American health care. Medical technology saves lives and relieves suffering, and is enormously popular with the public, profitable for doctors, and a source of great wealth for industry. Yet its costs are rising at a dangerously unsustainable rate. The control of technology costs poses a terrible ethical and policy dilemma. How can we deny people what they may need to live and flourish? Yet is it not also harmful to let rising costs strangle our health care system, eventually harming everyone?
In Taming the Beloved Beast, esteemed medical ethicist Daniel Callahan confronts this dilemma head-on. He argues that we can't escape it by organizational changes alone. Nothing less than a fundamental transformation of our thinking about health care is needed to achieve lasting and economically sustainable reform. The technology bubble, he contends, is beginning to burst.
Callahan weighs the ethical arguments for and against limiting the use of medical technologies, and he argues that reining in health care costs requires us to change entrenched values about progress and technological innovation. Taming the Beloved Beast shows that the cost crisis is as great as that of the uninsured. Only a government-regulated universal health care system can offer the hope of managing technology and making it affordable for all.

Daniel Callahan is senior researcher and president emeritus at the Hastings Center, which he cofounded, and an elected member of the Institute of Medicine of the National Academy of Sciences. His many books include Medicine and the Market.