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Comment by FfejL | Hacker News Reader

This is a horrible way to frame the study's finding. "1% of people are responsible" sounds like some group is wasting resources, or taking up an uneven share.

The study looks at one year, and finds in that one year 24% of spending was on 1% of the people receiving care. That's not very surprising. 30 years ago I was in a bad car accident. I'm sure the cost of the ambulance, the emergency surgery, and the after-care was WAY more than most people average that year, and easily the most expensive medical year of my life. But it was just that one time.

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I liked the comparison someone offered in a reply to the post saying "5% of people buy 50% of the houses", which of course isn't because of disproportionate house buying but because most people don't buy a house every year.

To be somewhat fair to the original poster, they do offer a graph further down talking about total lifetime healthcare spending by percentile, which is also somewhat imbalanced and would account for spikes in healthcare spending by individuals due to accidents or temporary sickness. But despite being a better dataset to cite to make their point, they clearly didn't lead with the lifetime spending graph because it's significantly less imbalanced than just picking a specific year and so makes their argument weaker (if also more accurate).

Totally true. For a car insurer you are looking at what, 500 years of premium for a serious total loss collision? That means 499 people get nothing (drama?!). Actually this percentage (the “24%”) gets higher the more extreme the covered events are. Daresay, a low percentage suggests something shouldn’t be insured, since it’s a regular event and people shouldn’t pay the insurers overhead and margin for something they could save for. So the suggestion that “1%”-“24%” is a wrong combination gets the nature of insurance exactly wrong. I read the 5% in OP that once in twenty years you get a serious condition where no expenses are spared to save you. That’s amazing. (Opinions on absolute US health spending are another topic.)

Actuarial people do this sort of analysis all the time. It’s a valid tool, it doesn’t mean you have to give up your moral compass.

The framing immediately put me on guard. It feels like clear manipulation to direct hostility at this ‘1%.’

I'll gladly pay my share and hope I'll never be part of that 1%.

'Health spending' doesn't specify the source of payment so much of that responsibility could have been borne out-of-pocket.

There are actually two charts. One is for total and one is for out of pocket.

https://www.kff.org/health-policy-101-health-care-costs-and-...

100% of the 25% will be in the 1% group—or die.

Wonder if it’s some psyops so people start wondering: “look at how these old people are abusing Medicare, we need to repeal“.

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