Healthcare executives know and frequently recite that the majority of health care expenditures in a given year are from an incredibly small number of patients.    I don’t believe our U.S. citizenry generally understands neither this fact nor its implications.     I have heard various numbers over the years – 5% of patients account for more than 50% of the spend or as this WSJ article (sorry subscription required) on “The Crushing Cost of Care” reports — 10% of Medicare beneficiaries account for 64% of Medicare hospital spend in 2009.    There are two main drivers for this concentrated spending distribution – people with chronic conditions (more accurately multiple chronic conditions) and as demonstrated by the WSJ article – end of life care.

I don’t claim to know the right answer or even how to frame a constructive dialog about end of life care. (Check out the comments to the WSJ article as a depressing start).   Personally I have had to deal with several family members end of life issues and they are incredibly emotional and challenging without having to consider economic consequences.  However, I believe and have frequently written that ‘health care’ is an economic good.  As such, we (society) don’t have a limitless ability to supply ‘free’ health care.   Our country is nearly broke today – and when one considers existing entitlement spending projected into the future, especially on health – we know we can’t afford it without some change.    Furthermore, our current framework of indirect payments and complete lack of transparency of costs to both physicians and patients exacerbates the problem.

Neither political party is being responsible regarding this issue.   The Republican sound bite about “death panels” is inappropriately used as a political weapon that shuts down public education and constructive dialog – and ultimately makes the problem worse.   The Democrats fail to acknowledge that the current system is simply unsustainable economically and as a result forces the ultimate economic trade-offs to a faceless bureaucracy (the wrong place) and gives credence to the Republican argument.   Both sides are being disingenuous if not dishonest – which is not helping society learn how to deal with the amazing benefits/possibilities/costs of modern medicine and the inevitability of death and the moral dilemmas for doctors, patients and families that result.