The 1%… Healthcare

Here are some interesting facts that those outside the medical industry might not know.  It appeared in a recent USA Today article.   One percent of Americans accounted for 22% of health care costs in 2009, according to a federal report released Wednesday.  Want more?  Five percent accounted for 50% of health care costs.   They tended to be white, non-Hispanic women in poor health,the elderly, and users of publicly funded health care.  We doctors knew this all along.   We know many patients who just consume our time and healthcare dollars to the detriment of others who really could use it.   This is all similar to that 80/20 rule where 20% of our patients take up 80% of our time.   So where are the protests against these 1% from the other 99%?  Well, there won’t be because this information does nothing for us.  It is too politically incorrect to touch and besides there is no one who will ever be able to make the hard calls.  End of life care is never easy and so much is spent in hospital costs at that time.   No one wants to pressure those people who get cheap or free care.  Doctors are afraid to cut back on these patients due to fears of being sued.   Unfortunately, the only answer is to SOMEHOW make these patients pay for at least for some of their care.  It doesn’t even have to be much.   There should be a study to find that number.  I have seen it over and over again.   Once they have their own skin in the game they will stop pursuing that chronic journey to find some mystical fix to all their ailments.



Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “The 1%… Healthcare

  1. January 21, 2012 at 1:03 pm

    When the family dog is old, debilitated, with multiple problems that are only worsening, people take them to the Vet and the dog is mercifully “put down.” Although that is not something I feel comfortable doing to humans, intellectually I believe it may well be a cultural phenomenon. It may be an educational issue. Perhaps it should change. We all have anecdotal experiences when we thought the “do everything” approach was being cruel to the patient. Somehow, there must be a way to be kinder to these people with their very sad problems. Certainly, the Health Care Directive has not worked out as well as we thought it would, but it was a good step forward. Hopefully, someone smarter than I can figure this out. So many people and their families can be helped.

  2. CancerDoc
    January 19, 2012 at 6:15 am

    This is so true. As an oncologist who also does heme-related consults in the hospital, I see it all the time. The patient with metastatic chemo-resistant cancer who demands to be a “full code” despite the fact there is nothing that can be reasonably done for the cancer, the family of the patient with end organ disease, now in multi system failure from an infectious complication who refuses to withdraw care and keeps Dad on the vent for 2 weeks because they need “emotional closure.” When I listen to mass media, rising medical costs are always blamed on physicians….and we are partially to blame. However, in the realm of end of life care, I believe much of the cost is family/patient driven with physicians painted into a corner from fear of litigation. Then, the inappropriate over-treatment becomes the “community standard” and the fear of litigation is a reality. There are a few physicians that will always be uncomfortable with death and push for treatment offering a slim hope of improvement to families.

    When I have end of life conversations regarding code status with patients that really have no good prognosis if they were to code (i.e. die), the answer comes back “but I want to live.” At one level that’s healthy, but the reality is the 80 year old with CHF, COPD and metastatic cancer refractory to two lines of chemotherapy just isn’t going to do well. But if he dies, he will be coded, and potentially consume days of ICU care before he finally dies. Families don’t realize that there is no dignity in that sort of death, that “doing every thing” can actually be abusive rather than loving. I wish someone would do a reality show with real codes of real dying people that demonstrates how abusive doing everything really is….show the person thrashing on the vent, amplify the sound of breaking ribs during chest compressions, witness the decubitus ulcers on a patient with contractures after the slow descent into non-verbal dementia being placed on a cold CT scan table for yet another scan to evaluate “altered mental status.” Sorry, you hit my sore spot.

  3. jo
    January 18, 2012 at 9:06 pm

    I have said for years that if the family had to pay for grandma’s end of life care out of their inheritance, instead of hearing, “Oh, we just can’t let go of Grandma yet,” we’d be hearing “Grandma had a good life. It is time to let her go.”

  4. January 18, 2012 at 2:32 pm

    If Medicare and Medicaid would pay for Urgent Care, we could reduce those health costs by a significant percentage — trips to the Emergency Room are often the only way a poor person can get into health care, and are the most expensive form of treatment. This isn’t about fraud, it’s about stupidity.

  5. Andy
    January 18, 2012 at 10:01 am

    I once read that in Britian, the NHS was looking for a way to cut down on nuciance Doctor visits. The solution, they instituted a co-pay that was approximately the cost of two pints at the local pub. Supposedly saw something like a 40% decrease in nuciance visits.

  6. January 18, 2012 at 1:11 am

    Amen Doug! And squeamish hospital CEOs should stick to their guns and turn those away from the ER with no emergency condition, and no expectation to even try to pay. Moreover, I’d cheerfully support an ER “visit limit” for all gov’t patients – that means you Medicaid AND Medicare – with no emergency condition. I just love the 18 year old healthy Medicaid leeches at the triage window saying calmly “chest pain”, expecting to be rushed right in.

  7. DefendUSA
    January 17, 2012 at 7:14 pm

    You know, THAT is the key. Skin in the game. Period. Fee for service. Boom…like the old days.

    • Kelli Strauss, M.D., Family Practice
      January 21, 2012 at 8:33 pm

      I absolutely agree with this concept–if patients are given totally free access to health care, they quickly tend to abuse the priviledge. If they are required to pay EVEN A SMALL amount for that care, they think twice about coming in for inconsequential complaints.

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