The "solution" to our escalating health care costs of having an open "market," where "consumers" have a financial incentive to choose economically, and can select based on costs and benefits, fails to take into account the fact that choice has little opportunity to operate in the vast majority of such spending. When you're scheduling your colonoscopy or cataract surgery (or many other non-urgent and relatively inexpensive procedures), or even finding a primary care doctor, it would reduce costs and promote competition if patients were able select from a list that included charges and a rating of the providers. But when someone has a heart attack, or is severely injured in an MVA, s/he is not in a position either to negotiate a price or to select the place of treatment based on its costs. When you are told you have cancer, finding the least expensive treatment is not likely to be your major consideration. When your elderly mother is in the ICU on a ventilator recovering from pneumonia and other complications of gallbladder surgery, your decisions on her management will probably not revolve primarily on saving money. Until docs and hospitals are paid based on patient outcomes (or at least for providing optimal care), and not on how much is done (especially how many procedures are done, a particularly important consideration in my specialty, cardiology), the chances of significantly moderating health care costs are slim to none. Possible realistic potential solutions include paying for episodes of care (see http://en.wikipedia.org/wiki/Bundled_payment), and integrated systems of care, where the primary care docs, specialists, clinics, hospitals, convalescent facilities, etc, are all part of the same system, such as Group Health (Seattle) and Kaiser Permanente (primarily on the west coast). But both would require significant changes in the structure of health care in the US, something that does not appear about to happen. Robin M. Lake, MD, FACC, FCCP

When the small nuclear weapon is smuggled into Los Angeles by terrorists, the toll WILL be in the millions.