On fancy machines
There was an episode of ER where a doctor returned from some time in Africa with Doctors Without Borders. He was convinced we over-tested and over-diagnosed people, and started canceling orders for MRIs where he didn't think it was necessary.
Then someone explained to him why the U.S. system wasn't like Africa. Here, we do have the big fancy equipment. It's usually not needed, but when it is there's nothing better. Thing is, it's a massive fixed cost. If you only used it the 20 times a year you really need it, you'd have to charge each of those patients $50k. So instead you use it once or twice a day and charge each patient's insurance company a few thousand. Thats how you can afford to have the machine.
No, I have no idea how to fix this. Or at least no idea that would ever make it through congress.
