Diagnosing the 21st Century Health Care Dilemma

Discover the basic factors that are contributing to inflated health care costs and, ultimately, shaping the American medical experience.


| November 2015



asian man getting dialysis treatment in hospital

Life-sustaining treatments, such as dialysis, that were once considered rare have become accepted as common treatment options in today’s health care system.

Photo by Fotolia/Trish23

The line between life-giving therapies and too much treatment is hard to see. In Ordinary Medicine (Duke University Press, 2015) medical anthropologist Sharon Kaufman investigates the drive behind the “more is better” approach to medicine, while striving to rethink and reshape medicine’s goals. The following excerpt taken from the Introduction briefly describes the dilemmas modern American health care faces and how Kaufman has gained insight into the field.

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Diagnosing Twenty-First-Century Health Care

“Medicine today comprises an unthinkably broad array of knowledge and skills, professions, coalitions, and interest groups, fears and promises, fantasies and soon-to-be-realities, concrete and virtual institutions, folklores and sciences.” —Arthur Frank, The Renewal of Generosity

Medicine has changed radically over the past fifteen years. Some of those changes are obvious and dramatic and have provided welcome benefits. Who doesn’t welcome the availability of cholesterol- lowering drugs, joint replacements and arthroscopic surgery, the anti-retrovirals that have made AIDS a chronic, manageable illness, and so much more?

Other equally obvious and dramatic changes, however, have become the subject of widespread lament: too much life-sustaining but death-prolonging technology is being used at the end of life; drug companies are paying physicians to promote their products; expensive tests, devices, and procedures are overused; drug costs, especially for cancer treatment, have skyrocketed, yet the new drugs don’t necessarily offer better results than existing treatments. Most everyone who has had intimate dealings with the U.S. health care system of late can add to this list of obvious and well-publicized problems.

However, many equally dramatic and relatively recent changes within the U.S. health care delivery system are far less visible—indeed I contend that they are very well hidden. But although they function well below the radar of scrutiny, these changes have not just complicated medical practice and health care delivery but actually have altered their very nature. They have also altered how and what we think about health per se and about the options we have for controlling our life span and that of our loved ones. Therein lies the health care dilemma that patients, families, and providers by the millions face every day.