Moreover, the whole idea behind the “health care as consumer” movement is that the problem is we use too much health care. If we spent more of our own money, we wouldn’t take those “recreational visits” to the emergency room or orthopedic surgeon. Two cracks in that theory. First, the research we have suggests people avoid both unneeded AND needed medical care when they pay the bills themselves. Secondly, the major reason we Americans spend so much more than, say, Canada or Germany, isn’t use rates, it’s prices. We pay more for everything we get from the health care system.