Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care. And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government intrudes.
Now that isn’t to say that there aren’t some legitimate concerns involved in expanding access to health care in this country, because there are. For instance, we already have areas in this country with a shortage of physicians, and when uninsured people are suddenly insured, their demand for services will be actualized and the physician shortage will be exacerbated. Some people take that to mean that they won’t be able to see a doctor without bread line depression-era style waits. I don’t think that’s remotely close to what will actually happen, but even if it did, there would be a simple fix: produce more doctors in this country. Plenty of smart, talented people are denied admission to U.S. medical schools every year. I honestly do not think that the quality of U.S. medical care would suffer by extending enrollment at the margins.
Then there’s the issue of rationing that people fear will go on at the doctor’s office. They worry that in a governmental effort to “pinch pennies” patients won’t be able to get the best care like they supposedly can now. There’s a tremendous amount of concern about the idea of evidence-based medicine. Apparently people don’t trust the name–or else they prefer their treatments to be based on something other than evidence. An article just published in Health Affairs gets to the root of these fears. The study’s authors basically find that people don’t know what evidence-based medicine really means, don’t tend to get involved in decision making about their health care (preferring their physicians to make the decisions), and continue to hold on strongly to the belief that more care–and more expensive care–is always better. You would think that an entire nation of people raised up on the fairytale of Goldilocks and the Three Bears would realize that extremes in either direction aren’t usually the best course of action. Still, the authors found that people translate the phrase evidence-based medicine to mean that the government steps in and tells doctors how they have to practice by establishing evidence-based guidelines that can’t be overridden or changed in any way. That view, unfortunately, is just plain wrong, and explains how the public’s misconceptions remain one of the greatest barriers to improving our health care system.