It is encouraging to see federal officials taking a hard look at the costs versus benefits of extensive use of new health-care technologies. No one can deny the long-term results of new insights from new tools such as positron emission tomography scanners, but does every ailment require the machine's penetrating exactitude?
Such questions were asked in the late 1970s, when state health regulators began to doubt the need for computer tomography scanners in hospitals with small patient loads. Computer tomography revolutionized X-ray exams, showing doctors pictures never before seen, but many said they couldn't interpret what they were getting. It made far more sense to locate such machines in larger medical centers, which saw many illnesses for which scanners were needed, with other hospitals referring patients -- but doctors would not hear of it. CAT scanners, which cost more than $1 million each and up to $500 for each use, proliferated.
The scenario was repeated when magnetic resonance imaging appeared in the mid-1980s. Health regulators in some states tried to require certificates before hospitals could buy new equipment and pass the bill to patients, but medical entrepreneurs made an end run. Private imaging centers sprang up, evading the certificate requirements but making handsome profits for their owners.