Making longevity in an aging society: linking ethical sensibility and Medicare spending.

An aging society, a growing array of life-extending medical interventions, Medicare policy, and an ethic of individual decision making together contribute to the deepening societal tension in the United States between controlling health care costs and enabling health consumer use of life-sustaining technologies. The activities that constitute longevity making, like so many other sociomedical practices, comprise a site for the governing of life and the emergence of new forms of ethical comportment and social participation. Those activities--including the necessity of treating risk, the difficulty of saying "no" to evidence-based interventions, and the responsibility of choosing among clinical options--also lie at the heart of debates about health care rationing and reform. Cardiac procedures, organ transplantation, and cancer treatments are three examples of medicine's success in extending life and are emblematic of the existential and societal quandaries that result. A perspective from medical anthropology shows the ways in which the making of life is linked to health care spending and the ongoing debates about age-based rationing.