Response to James H. Maxwell's Essay, "The Iron Lung"

Abstract

the 1971 essay, which seems to be the beginning of James Maxwell's disagreement with my way of looking at things. I did indeed express misgivings about halfway technologies, although not quite in the terms attributed to me. I was principally worried about the future costs of such measures, especially the transplantation of kidneys and hearts, chronic renal dialysis, and, most frightening of all, the prospect even back then of the development of an artificial heart. What now catches my eye in the essay is the figure $80 billion a year, which was the rough 1971 estimate of the nation's total cost of what I referred to as medical care, now more fashionably known as Health Care Delivery System. The number for the year 1950 had been $10 billion. That was startling, but not as startling as what happened later, with the estimated figure for 1985 now pegged at around $350 billion. So, we still have the same sort of problem, getting worse. To jump so easily from $10 to $80 to $350 billion in 35 years, even allowing for inflation during those years, should be making us nervous for the future. Part of the increase-I cannot find reliable estimates of just how much, but surely a significant part-can be assigned to the new and increasingly complex technologies brought into use year after year for medical diagnosis and therapy.