Reviews the changes in federal government involvement in medical technology in the past decade, from prior reliance upon nongovernmental decisionmaking about development, diffusion, and use, to increasingly centralized decisionmaking. The case of end-stage renal disease offers contrasts between the past and present. The cases of Karen Ann Quinlan and CT scanning indicate the source of present skepticism about benefits and costs of medical technology. Current federal involvement in medical technology decisionmaking, through health planning, medical device regulation, and increased formal analysis of safety, effectiveness, and cost-effectiveness, is described. Though increased federal involvement in medical technology stems from a desire to compensate for failures of the medical marketplace, the immediate effect is to place greater decisionmaking reliance upon formal analysis, bureaucracy, legal procedure, and politics. It is unclear whether the result of increased federal involvement will produce beneficial outcomes.