My column this week was an attempt to step out of the political system’s comfort zone on health care and consider some approaches that seem radical to us, but are perhaps necessary going forward. But I was just talking about how we deliver health insurance. Daniel Callahan and Sherwin Nulland are talking about who we treat, and how we handle death.

The traditional open-ended model of medical research, with the war against death as the highest priority, should give way to a new goal: aiming to bring everyone’s life expectancy up to an average age of 80 years (already being approached), reducing early death, and shifting the emphasis in the direction of improving the quality of life of those in every age group. The highest priority should be given to children, the next-highest to those in their adult years (the age group responsible for managing society), and the lowest to those over 80.

In light of the fact that we are not curing most diseases, we need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person. An old age marked by disability, economic insecurity, and social isolation are also great evils. Instead of a medical culture of cure for the elderly we need a culture of care, notably a stronger Social Security program and a Medicare program much more heavily weighted toward primary care. Less money, that is, for late-life technological interventions and more for preventive measures and independent living. Some people may die earlier than now, but they will die better deaths.

I don’t agree with everything in their essay. But it’s a bracing, important read. And note that it’s not really an argument about how policymakers should think about medicine. It’s an argument about how doctors should think about their patients. So let’s do better than a big government vs. small government argument in the comments.