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: