Only a few spend the most

Efforts to cut health-care costs are complicated by the fact that medical dollars are spent on a relatively tiny sliver of the patient population. High-deductible plans will not make much of a dent in that group.

The healthiest 50 percent of Americans spend only about 3 percent of health-care dollars. On the other hand, more than $1 out of $5 health-care dollars are spent on the sickest 1 percent. The top 5 percent accounted for about half of total spending in 2009.

Technology and the market power of monopoly health-care organizations drive the lion’s share of medical inflation. Unless we want a highly regulated health-care system, those two factors are out of our control. The only other way to control health-care spending is to use less of it. We need the healthiest 50 percent to stay healthy.