Another key fact that is discussed infrequently is the high concentration of health care expenditures in a small population. A recent study found that five percent of Americans are responsible for nearly HALF of all health spending in a given year. An earlier study found that it was over half. Also, almost half of the U.S. incurs little to no health care costs and thus the other 50 percent make up about 95% plus of the health care spending. This concentration is interesting at other levels as well. The top 30 percent of spenders make up 90% of health spending; while the top 10 percent make up nearly 70%.
These statistics speak the need for a more holistic view of reform. Increasing quality, decreasing costs, and expanding coverage all are worthy goals but they cannot be goals divorced from the social reality of health care needs. Both studies find that the elderly are more likely to bear the burden of high expenditures. Also, they found that people with chronic conditions had much higher out-of-pocket expenses than average. Better, more cost-effective treatment is needed for these folks. Often their situation is compounded by the fact that they may reach their lifetime spending cap and lose coverage. In turn, due to pre-existing conditions clauses, they may have an extremely difficult time getting other coverage, and if they do it will be exhorbitantly expensive until they are so drained of money they can qualify for Medicaid.
All these factors indicate the importance of having a coherent, nationally focused health care reform. The reform must be tailored to meet the needs of different populations and levels of care. However, everyone should have to have insurance; at the very least, catastrophic coverage. It is in the best interest of the long term health of the American people and in the best interest of our financial well-being, both individually and as a society. People without insurance coverage that require medical treatment incur higher costs and are much more likely to face bankruptcy as a result. Of course, there must be subsidies to help those who would not be able to afford coverage themselves.
During the current health care reform I have continually been dismayed by the process and how easily many of those involved lose sight of the overall goals and the purpose reform serves. We don't need reform for the sake of reform. Sure the system is broken, but a patchwork solution will only push the need for a more significant reform off the radar for another decade or two. We have hard decisions to make. Until we face those decisions with a sense of history and an eye to the future, we will continue to create policy that only serves to line the pockets of those who are currently abusing the system.