We’ve got it for you right here-again (click on the image to get a crisper picture):
We published a columnar version of this data in a previous post, on October 13. We feel this chart depicts the health investment* management challenge more accurately – and more starkly.
Note that we did not say it’s the single most important chart in all of US health care spending. Because it’s more than that. The spending discrepancies serve to illustrate that the hodgepodge of services and products we lump together as “health care” are widely divergent, so much so as to render their assembly in one category practically useless.
Note also that we have used a chart built on 2008 data; we might have updated it, but a) we’re lazy (note the long gap between this post and our last one) and b) the relationships among the various spending groups have not changed all that much.
So why is this the single most important chart in all of US health care?
Because it makes quite clear that the distribution of health care, and costs, is not normal**. Which makes thinking about potential solutions to unmanaged health care costs in normal terms almost entirely useless.
Let’s look at health care costs for the “luckiest” 50% of us – those on whom the least is spent in a year (obviously there are people in that group on whom more should be spent, but that’s a conversation for another post). The average annual sum spent on medical care for each person in that group is $233. If our entire population is 100 people, spending on care for the lowest 50% totals $11,650.
And spending on the person who accounts for the greatest 1% is $76,476 – over THREE HUNDRED TIMES the “health care spending” for each person in the half of the population on whom the lowest average amount was spent. Spending on that single person is over six times as much as the total spent on the one-half of our population that comprises the lowest 50% of spending.
Thinking about health care and costs that affect half of us in the same terms as we think about the care and costs that impact 1 in 100 of us does not make any sense at all. The two are as different as can be. In fact it’s kind of kooky to call them both “health care”.
Yet the typical health care cost story in our popular media points to “average” costs, as if we would solve our problems if only we could control the “average” person’s medical spending more effectively.
If we are going to “solve” our medical spending challenge, we literally have to redefine what it is we are talking about. We have to think about it in entirely different ways.
*terms like “health care spending” or “health care costs” pre-empt useful conversation about “what to do about health care” – but more on that elsewhere.
**”Normal” here is intended to draw on the term’s multiple meanings. Medical care spending in a sample US population is not normally distributed; that is, spending by member individuals does not cluster around the average for the population. Calling the actual distribution of spending “not normal” is also intended to help the reader understand that s/he needs to think about medical spending issues much, much differently than they are probably accustomed to.
30
Jul 12
Why We Don’t Face an ACA-Driven Doctor Shortage
I’ve come to the view that the “looming doctor shortage due to ACA” meme is kind of – funny. This article reinforces that view for me:
Doctor Shortage Likely To Worsen With Health Law (Ann Lowrey and Robert Pear, New York Times, 7/29/12)
Why? Because we already have a doctor shortage. We had a doctor shortage, and a declining number of doctors per X number of people in the general population, BEFORE the advent of ACA. (Incidentally, we’re ignoring without inspection the notion expressed by some cranks that significant numbers of physicians will leave the field due to the advent of a statute the chief features of which are an infusion of additional funds into the health care system, and liberalized access to physician services. Some contentions are beneath interrogation.)
We may as well be warning one another of a “payment source availability surplus” – that is, a sudden upward shift in the amount of dough promised to pay for physician visits, even though there aren’t enough physicians for people who will now have access to these promised payments to visit.
Oh wait; maybe that’s what we’re actually doing. Because wouldn’t people who need physician attention now, but don’t seek it because they don’t have a source of payment, go ahead and seek it if they DID have a source of payment handy?
I can here you out there muttering that “that seems like a bunch of confusing nonsense”. Maybe you’re beginning to understand my dissatisfaction with the “doctor shortage” framing.
One point the article makes that I am NOT dissatisfied with:
What we understand to be care will take different forms than we’re accustomed to. You have a particular level of doctor shortage only if you simultaneously insist (intentionally or not) that care is only care if it is conducted in a specific way; a way that is already in place. Ought we have more physicians, or a different skills/practice mix among the US physicians already practicing? Perhaps. That conversation is quite different from the one the Times reporters seem to be pursuing.
Contrast the “we have a doctor shortage” story line with the thrust of this story, also from the NY Times (this one in the Magazine section):
What Mississippi Can Learn From Iran
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