Too much of a good thing: how splendid technologies can go wrong.

I begin with a brief account of my ordinary workday. Professionally I am engrossed in matters of national health policy, and particularly the growing cost of health care, once again into double digit inflation. Those costs are increasing the number of uninsured, putting great pressure on the federal programs of Medicare and Medicaid, and threatening employer-provided health insurance. What is to be done about that? To get to my place of work, up the Hudson River, I cross the Tappan Zee Bridge, which is choked with cars, well beyond its original projected capacity, and fed by a highway that features daily traffic jams. What is to be done about that? The main source of rising health care costs is the emergence of new technologies and the intensified use of old technologies, accounting for some 40 percent of the annual increase. The main source of the traffic problem, here and elsewhere, is simply too many cars, ever increasing in number. Not many people see analogies between health care technologies and automobiles, but there is nothing like sitting in a traffic jam to expand one's imagination. The problems are more alike than anyone might guess. Both problems raise two familiar questions, now in a new guise. One is ancient: how should we cope with those features of our lives, and thus of our human nature, where what is good gradually turns into something bad, usually inadvertently? Medical technology is an uncommon human benefit, but when its pursuit and deployment begin to create economic fits, public and private, its good begins to turn bad. The automobile increases freedom and mobility, and like medical technology is a source of enormous national economic benefit. But when our air is besmogged, our highways jammed, and our commutes a misery, its good turns bad. The second question my two illustrative technologies raise is this: is technology simply a neutral reality, neither good nor bad in itself, but to be evaluated solely on the basis of the uses to which it is put--or does it have a life of its own, subtly shaping our values and ways of life whether we choose that to happen or not? As opponents of gun control are fond of saying "Guns don't kill; only people kill." That may be narrowly true, but is it the full truth? Is it irrelevant for our safety how many guns we have in our house? And are we fully free--the autonomous creatures we are alleged to be--to use or not use medical technology as we like, or to drive or not drive an automobile, or does each technology draw us to its use in ways often beyond our control? While there are some people who cleverly manage to avoid the health care system altogether, putting their faith in prayer or austere living or exotic jungle potions, most of us can't get away with that. When we hurt we go to the doctor, and doctors these days turn to technology to diagnose us and to treat us. We expect no less. And while there are some strange creatures in Manhattan who have never learned to drive, few of us have successfully evaded the American car culture. In short, medical technology and the automobile are social realities most of us cannot imagine living without. In each case we can preach moderation; in each, moderation has proved hard to come by. In each case, the cumulative social impact of the technologies seems beyond our control, in great part precisely because it is a good that we cannot easily do without and which (of its very nature?) leads us to want more of it than we now have. The Ends of Technology Technology responds to some deep and enduring human needs: for survival (agriculture, defense); for increased choice, pleasure, and convenience (telephones, movies, escalators); for economic benefit (computers and software, machine tools, airplanes for export); for liberating visions of human possibility (space travel, instant world-wide communication). Medical technology and the automobile have many if not most of these attractions, and serve most of those needs. …