They aren't in business for their health . . .

. . . or yours, necessarily. Mike Mitka, in the new JAMA, discusses recent findings on what happens when physicians have a financial interest in medical imaging services. (I think you aren't allowed to read it because you are mere commoners, so I've linked to the extract.)

It is common for orthopedists to invest in MRI scanners and such, and it has long been observed based on insurance data (what we in the biz call "claims" data) that they tend to send more of their patients to have pictures taken of their insides when they get a piece of the action. However, the docs who do this claim that their patients just happen to be sicker or in more pain than other doctors' patients. I agree that doesn't seem highly plausible, but they say it anyway. Mitka reports on research done at Duke that finds a group of orthopedic surgeons who had an interest in MRI scanners had 86% more negative scans than a group with no such interest. Put another way, 42% of patients from the financial interest group had negative scans compared with 23% from the group without a financial interest.

A meta-analysis (pooling data from various studies) of claims data finds that physicians who do such "self-referral" do more than twice as many imaging tests as physicians who refer out to an independent radiologist, in all sorts of conditions.

I tell you all this because it is just one more way in which the mythical "free market" does not work in health care. It is what we call provider induced demand. Patients don't decide whether they need an MRI, doctors do. And if doctors are getting paid to do them, they'll do more of them, whether you really need it or not. And no, it wouldn't work to have you pay out of pocket because you have no idea whether you need an MRI or not and chances are, you wouldn't get one if you really did need it.

The solution is to make sure that doctors make these decisions untainted by financial interest, one way or the other. In other words, this just doesn't work as a market transaction. There are lots of other reasons why it doesn't but this one ought to be obvious even to Ron Paul (although I doubt that it is).

The most straightforward, best and smartest solution is universal, comprehensive, single payer national health care. That's what we need.