Among the most pernicious and blatantly false Republican talking points designed to obstruct health care reform is the fear-mongering claim that Democratic proposals will lead to "rationing." Of course, with almost 50 million uninsured and another 25 million underinsured, Mitch McConnell's dystopian future of a system which "denies, delays, or rations health care" is already today's nightmare for millions of Americans. But as it turns out, recent studies show that the market failure that is the crumbling U.S. health care system is producing a another, often hidden crisis: self-rationing.

As McClatchy reported last week, a new Consumers Union survey revealed that due to skyrocketing costs and reductions in coverage, Americans are forced to deny themselves needed medical treatment. Among the findings of CU's poll of a 1,002 respondents:

In the new poll 59 percent said that the cost of their health care had increased more than their other expenses over the past two years. Fifty-one percent said they had faced difficult health care choices in the past year. The most common responses were putting off a doctor visit because of cost (28 percent), not being unable to afford medical bills or medication (25 percent), and putting off a medical procedure because of cost (22 percent).

Twenty-eight percent said they had lost or experienced cutbacks in their health care coverage in the past year. The greatest concerns about health care expressed by respondents were a major financial loss or setback from medical cost due to an illness or accident (73 percent), not being able to afford health care in the future (73 percent), necessary care being denied or rationed by health insurance companies (73 percent), and the prospect of rising costs forcing them to choose between health care and other necessities (64 percent).

Those dismal results echoed the shocking revelations from an April 2009 Thomson Reuters survey.

That poll of 12,000 people not only found that employer-provided health care coverage had plummeted to 54.9% in 2009 from 59% in early 2008, but that 20% of Americans have postponed or delayed medical care. That 1 in 5 figure is a staggering jump from 15.9% in 2006.

Other jaw-dropping numbers from the Thomson Reuters study:

In the most recent survey, 21 percent of U.S. adults expected to have difficulty paying for health insurance or healthcare services in the next three months...

More than 54 percent who skipped care said they missed a doctor visit. Eight percent said they delayed or skipped medical imaging of some sort.

What Republican orthodoxy sees as the appropriate functioning of the health care market are instead the vital signs of its failure. (And other studies show that the conservative prescription, so-called "consumer-driven health care," would only make things worse.) Costs rising at triple the rate of wages, $13,000 family premiums per year rising to $22,000 by 2019, double-digit annual increases for next year, 62% of personal bankruptcies due to medical costs, declining emergency room capacity, health insurance near-monopolies in 94% of U.S. markets are just some of the indicators of a flat-lining U.S. health care system. It's now wonder Gary Pickens of the Healthcare division of Thomson Reuters concluded:

"If this trend continues, it will ultimately have an impact on our collective well-being."

For his part, Senate Minority Leader McConnell, whose home state of Kentucky ranks near the bottom in health care performance, continues to argue, "Americans want to see changes in the health care system. But they don't want changes that deny, delay, or ration care."

Of course, that's precisely what they are doing now.

(This piece also appears at Perrspectives.)