The Most Important US Health Policy Graph
I guess I could’ve done this myself, but thanks to Kaiser for doing it. I’m starting to think, as our title states, that pretty much everyone should see this graph. It affects how people understand health care, health policy, the uninsured, Medicare, Medicaid, everything.
Ready?
Okay, I know it’s just a bar graph, but read it. Seriously. I’ll wait.
You’re not reading.
Okay fine. Look at that. The 5% sickest people in our country make up HALF of our costs. The HALF of us that are the healthiest make up 3.4% of our costs. And the sickest people aren’t generally people that you see and think “Wow, they look ill.” They’re 10 times sicker. They’re people that spend months–MONTHS–in an ICU. They get admitted for something serious, and then they get a hospital infection. Or they have something else bad happen to them. They’re incredibly, incredibly sick. They’re on 20+ medications. They’re probably at least 50, if not 60, 70, 80, or 90. They probably have diabetes, high blood pressure, high cholesterol.
So see? When all the Talking Heads talk about “Health Savings Accounts” and being in control of your health care dollars, they’re focusing on a leaking faucet when there’s a Niagara Falls right next door.
It has to make one question how we’re spending our healthcare dollars. We’re shooting ourselves in the foot. Instead of providing preventive care and basic primary care to people, we wait until they get so very sick that they end up in the Intensive Care Unit, on 20 drugs.
Instead of making sure they’re managing their diabetes (or preventing them from getting diabetes in the first place), we let them get sick.
And once they’re so sick that they’ll likely never recover, we can keep them alive almost indefinitely, with no quality to their lives, just so we can hope and pray that they’ll recover… instead of keeping them healthy.
Is this not quite possibly the worst way to run a health care system, or is it just me?
(Big thanks to Ezra Klein for pointing me to this.)
Part of the problem is that healthy people (myself included) don’t really feel the need to go and see the doctor more than once a year… so it’s hard to imagine how you could divert more money to boost the 3.5%. More screening tests? More sit-down and education time? I guess there are plenty of things that could be done.
As for the top 5% — they are the undead GOMERs. Since we are held hostage to statistics, it is important to preserve life and preserve face at any cost. (Look at how low our infant mortality rates are! Look at how good our 5 year **** survival rates are with these latest, most expensive name-brand drugs! Look look look!)
:-\
The x-axis of this chart is pretty ambiguous. It should probably mention that the US population is sorted from highest health care cost to lowest and then split up into percentiles. A Merri-Mekko chart would probably be more illustrative.
I need the Social Work grad student verion of you to be my mentor…if that makes any sense at all?!?
Writing that people are taking 90 medications is insane and discredits your otherwise valid point.
You have pointed your readers to a very important subject. Identifying that 5% of the sickest patients account for almost 50% of our health care expenditure is rather easy. Several years ago I read that Medicare has determined that about 75% of the total expenditure on the average Medicare recipient occurs in the last 6-12 months of their life. At the opposite end of the scale is the preemie that is born weighing 1 kilo or less. They cost hundreds of thousands of dollars.
Having identified the problems, dealing with it is another problem. You mention that the money spent on the sickest 5% could be better spent on preventative care. I doubt if many would argue with you on that. But, how do we control the costs incurred by the sickest 5%? Americans, at least those with insurance, expect that everything possible shall be done for them or their relatives. Since Medicare is probably one of the largest “single payor” in the U.S. one would expect that at some point Congress would have dealt with this issue but it hasn’t happened. The only way these costs are going to be controlled is to institute some form of health care rationing but that is not about to happen because it is a political “hot potato.” I doubt that in any country that has universal coverage, would you find a 70+ year old patient getting two bone marrow transplants for acute leukemia, an 88 yr old man being put on renal dialysis, a 90 yr old getting a CABG, or the wide spread use of organ transplants. Until there is established a rigid protocol to handle the sickest 5% and the malpractice situation is corrected we are not going to see this problem solved.
While you are on your research year, you might find time to investigate how the UK, Germany, Sweden, France, or Canada manage this problem.
If you re-read the post, “Think Before You Write,” you’ll see that I’m talking about the person’s age, not the number of meds they’re on. And I’ve seen patients prescribed 42 medications at once. So I’m halfway to 90 almost already.
That kiwi looks like a shmoo.
Terrible healthcare policy, but you must add to that terrible patient compliance/participation.