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.