False Hopes: Why America's Quest for Perfect Health is a Recipe for Failure.

• Author: Battin, Margaret P.

Give it up. That's well-known bioethicist Dan Callahan's new advice on what to do about expensive, extensive health care, and how to control the out-of-control costs of medicine. Give it up, or at least give up a lot of it.

This isn't new advice from the author. We're fortunate to have had plenty of advice over the years from Callahan, one of the most articulate and thoughtful bioethicists working anywhere in the world. The central idea all along has been a piece of basic, how-to-live-and-end-your-life advice to Americans:

don't fight it (death)

don't ask for it (expensive life-prolonging treatment)

don't expect society to provide it for you (elaborate, unusual treatment)

don't expect to get it (perfect health) unless you're willing to be responsible for it yourself.

Now, Callahan's advice has broadened from exhortations to patients into a full-scale critique of the medical establishment. He's always told us that, as patients, we shouldn't be greedy for more -- more medical treatment, more health care expenditures, more life. But now he adds to it a trenchant account of how our assumptions about the nature of medicine invite medicine to take control of us, to make us greedy for more.

Here's our mistake: We think of medicine as progressive and perfectionist. It's a science, after all. We trust that, given enough research time and money, medical science will continue to conquer our diseases and improve our health. And while we're not so naive as to suppose that we'll all be guaranteed it all the time, we still take perfect health as medicine's ultimate goal. In this way, we create medicine's agenda and then buy into it, so that we come to believe that this is what medicine can (and should) do for us.

But we trick ourselves: Medicine is, in actuality, "expansionary" and "progress-obsessed." It doesn't have our interests in mind as much as its own; it is more a huge conglomerate of increasingly commercial interests, creating new markets for its own procedures and products. It is like an enormous cancer that will swallow all our resources and dash all our hopes. America's quest for perfect health is a recipe for failure, a prescription for disaster.

What we need instead, argues Callahan, is a "sustainable," "steady-state" medicine, a health care system (preferably, a single-payer one) that would guarantee us a decent basic level of care and, in return, expect increased personal responsibility for health.

Such a system would emphasize public...