Or the effect could be that Lenox Hill Radiology discovers it's getting a ton of MRI patients, has utilization above 85%, and can now afford to get another mach

Or the effect could be that Lenox Hill Radiology discovers it's getting a ton of MRI patients, has utilization above 85%, and can now afford to get another machine. A group doing a thing well getting more business is typically not a bad thing. Yes, if it's a loss leader then bad things can happen - but that doesn't seem to be the case here. "Personal Responsibility" is just "making the market actually be a market". Markets are great - but situations where the person paying isn't the person choosing or receiving the benefit tend to be horrible in some dimension.