Going into the House health care debate today, it pays to keep in mind what the Republican party has identified as the real problem with American health care. Steve Benen in the Washington Monthly sums it up succinctly, quoting former Congressman Dick Armey, the guru of the tea party crowd: “The largest empirical problem we have in health care today is too many people are too overinsured.”
There it is, the right’s philosophy on American health care in 17 words. Most of us think the problem with the existing system is that we pay too much, get too little, and leave too many behind. Dick Armey sees the existing system and thinks we’d all be better off with less coverage….
Just two months ago, Reps. John Shadegg (R-Ariz.) and Pete Hoekstra (R-Mich.) had an op-ed in the Wall Street Journal making the same case. “When was the last time you asked your doctor how much it would cost for a necessary test or procedure?” they asked, making the case that consumers need more “control … over their care.”
It’s all premised on the notion that health insurance encourages medical treatments. If we have coverage, we might get tests and procedures that we wouldn’t get if weren’t so darned insured. Less coverage means fewer costs.
This last point highlights an enduring myth about health care that has yet to be seriously challenged, even by Democrats, in the current debate. It’s the idea that if people had better access to health care, it would lead to “overuse,” and therefore to increased cost. That’s why we can’t have single-payer or any other reform that makes free or low-cost health care more available to more people—because without financial barriers, everyone would be running to the doctor every time they sneezed.
This myth treats medical procedures as if they were enjoyable leisure activities that everyone would like to partake of more often if only they were given the chance: “Gosh, I’ve got some free time today–-I think I’ll go sit in my doctor’s waiting room” or “Wow, I’d love to have another colonoscopy this month” or “Hey, why don’t I have my hip replaced—after all, it’s free.” The overuse myth suggests that a large portion of the U.S. population is suffering from Munchausen syndrome—or at the very least, that we are masochistic hypochodriacs.
In reality, there’s scant evidence that better access leads to overuse—although the opposite is certainly true. And the meteoric rise in health care costs, beginning in the 1990s, has no apparent relationship to greater access. As Physicians for a National Health Program pointed out several years back:
[T]hose with interests in rising health expenditures will try to make sure the American public does not understand the real causes of the recent surge in medical inflation. Their loudest argument is that Americans overuse medical care and that such overuse would only worsen if all Americans were insured.
Overuse does exist, the evidence indicates. But so does worrisome underuse. And overuse cannot explain the latest burst in health insurance prices or the sharp rises in what drugstores and doctors charge. There is no credible evidence that Americans received a lot more medical care in the past few years. But the price of health care has skyrocketed nonetheless. That inflation is because of the market power of insurers, drug manufacturers, hospitals and other suppliers of medical services.
PNHP also argues that ”the expectation that patients (especially the sickest 20 percent of the population that account for 80 percent of health spending) should be able to distinguish between what care is ‘necessary’ and what is not is fantastical.” In other words, if people are having too many costly treatments, it’s not because they are choosing to do so; it’s because they are being told to do so by parties with a vested interest in making money off those treatments.
The real myth is that a system of medicine-for-profit can yield sound health care. In the preface to his 1909 play The Doctor’s Dilemma, George Bernard Shaw (an early advocate of a publicly run health care system) described the internal contradiction inherent in this idea:
It is not the fault of our doctors that the medical service of the community, as at present provided for, is a murderous absurdity. That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid. He who corrects the ingrowing toe-nail receives a few shillings: he who cuts your inside out receives hundreds of guineas, except when he does it to a poor person for practice.
Scandalized voices murmur that these operations are necessary. They may be. It may also be necessary to hang a man or pull down a house. But we take good care not to make the hangman and the housebreaker the judges of that. If we did, no man’s neck would be safe and no man’s house stable.
Shaw’s words of advice for those approaching the private, profit-driven health care system: “Treat the private operator exactly as you would treat a private executioner.”
