Americans will not succeed in containing healthcare costs until they make some radical changes in the way they think about life, death, and the pursuit of good health. This is the contention of Daniel Callahan, who, in his new book, What Kind of Life: The Limits of Medical Progress, calls for a revolution of sorts-a change in the nation's psychological and political foundations. In Callahan's brave new world, limits rather than aspirations, risks rather than benefits, and pitfalls rather than opportunities would be emphasized. Research projects with costly and likely limited social payoffs would be rare; Americans, accustomed to demanding the most advanced technology that medicine has to offer, would have to accept the inevitability of disease and death. Callahan presents an outline for establishing healthcare priorities and rationing services. He frames those priorities within a context of limits on extending longevity and pursuing individual cures. The outline is pyramidal. Fewer people generally would receive health services as they ascend the pyramid's six levels, and the cost per person would rise dramatically. In this milieu, children would have "some priority" over adults, particularly the elderly.
美国人若不彻底改变他们对生命、死亡和追求健康的看法，就无法成功控制医疗成本。这是丹尼尔·卡拉汉的观点，他在新书《何种生活：医学进步的局限》中呼吁进行某种革命——改变国家的心理和政治基础。在卡拉汉描绘的美好新世界中，将强调局限而非抱负、风险而非益处、陷阱而非机遇。那些社会回报成本高昂且可能有限的研究项目将很少见；习惯了要求使用医学所能提供的最先进技术的美国人将不得不接受疾病和死亡的必然性。卡拉汉提出了一个确立医疗保健优先事项和配给服务的大纲。他将这些优先事项置于延长寿命和追求个体治愈的局限背景之下。该大纲呈金字塔形。随着人们在金字塔的六个层级上升，通常会有越来越少的人获得医疗服务，而人均成本将急剧上升。在这种环境下，儿童将比成年人，尤其是老年人“享有一些优先权”。
