On healing crystals and spine MRIs
The illusion of central planning precision
Americans spend a lot of money on things with questionable “value:” $150 billion annually for pet services, $1.5 billion for tattoos, $45 billion for food delivery and a whopping $450 billion on the non-medical “wellness” industry.
These crystals, aromatherapies, and dubious supplements are unlikely to produce anything we doctors would consider “valuable.” But value is in the eye of the consumer.
If a healing crystal provides a placebo effect, and someone values that effect more than their hard-earned cash, who are we to stop them? But here’s the key question: if they’re using someone else’s money, should they still be allowed to buy it?
And thus, we arrive at the quandary in which healthcare finds itself.
Because of our third-party payment system, payers are stuck trying to define “value” from above. Medicare, as a government-run payer, leans fully into central planning. It assigns prices from the top, determining the “value” of everything from a clinic visit to a brain tumor resection. Yet like a truly schizophrenic planner, it may give something a high reimbursement (suggesting it’s valuable) and then later label it “low-value” and call for more bureaucratic restrictions to reduce its use.
It’s like the government saying healing crystals are worth $10,000 each, then panicking when everyone starts selling them and trying to claw things back by declaring them low-value.
A recent paper in JAMA falls into this same trap. The authors want to save Medicare $25 billion by cutting “low-value” services. But like so many top-down cost-saving schemes, the paper is built on a technocratic conceit: that a centralized authority can definitively know what is “low-value” for all patients, in all contexts, at all times.
Take imaging for low back pain (item #31 in their list of low-value services). The authors say that a spine MRI is only high-value if it’s done for a narrow list of diagnoses. But that framework ignores the fundamental reality: value is subjective.
For a patient in agonizing pain, the psychological benefit of an early MRI can be immense, even if no actionable pathology is found. It offers reassurance. It validates suffering. For many patients, that peace of mind alone is worth the out-of-pocket cost.
Why should a committee in Washington decide whether that value is “real”?
Remember, Americans are already spending $450 billion a year on wellness products with zero evidence of benefit. Cutting $25 billion from Medicare is a rounding error.
If Medicare truly believes these services are low-value, why keep paying for them? The system talks out of both sides of its mouth: labeling care as wasteful on paper while reimbursing for it in practice, often quite generously. Either this care is so worthless it shouldn’t be reimbursed at all, or it holds enough value in some contexts that it deserves to exist without top-down suppression.
So why not let people spend their own money on these kinds of non-emergency medical services, just like they do with tattoos, lattes, or a taxi for their burrito?
Let’s shift these decisions closer to the point of care. Let patients pay out of pocket for low-back imaging, vitamin D screenings, or PSA tests. If affordability is the concern, the solution isd fewer intermediaries. Eliminate third-party payer distortion, and prices will fall. For the truly poor, government-sponsored HSAs could bridge the gap. (Yes, for this small, last group some light-touch planning is needed to prevent the state from paying for healing crystals.)
But for the vast majority of cases, the only decision-makers should be the patient and their doctor.
This is the genius of FA Hayek. He convincingly argued that no central planner, no matter how brilliant, can assign value, set prices, and distribute resources more effectively than millions of decentralized actors using local knowledge. Some will make bad choices. But on the whole, they’ll get it more right than even the best-intentioned committee.
In healthcare, a Hayekian model respects local knowledge, honors the subjectivity of value, and restores price as a signal.
It may sound virtuous to chase billions in savings by slashing “low-value care.” But efforts like these confuse bureaucratic labeling with clinical wisdom. The problem isn’t overuse. It’s misaligned incentives, opaque pricing, and a payment structure that severs the patient from the cost of care… and therefore from its value.
Until we realign the system around decentralized, patient-centered, market-based principles, studies like these won’t reduce waste.
They’ll just shift power.