The top 1 percent of health care spenders use more resources, collectively, than the bottom 75 percent, according to a new study based on national surveys. Slice the data a different way, and the bottom half of spenders all together rack up only about 3 percent of overall health care spending — a pattern hasn’t budged for decades. This creates a fundamental inequality in the country’s health spending that is the crux of the challenge policy makers face: They need a system that works for people who are ill, but is attractive to those who are healthy and spend little on health care.
A conservative vision of health care would have people take more responsibility for their own health care costs, but the graph above presents policy challenges as well, because it suggests that solution wouldn’t just be a matter of making people at all levels smarter shoppers. It would saddle those with the bad luck of being sick with costs that could quickly become untenable.
So what’s better. Bad luck of being sick = financial destruction. Or everybody gets hosed across the board?