Health Care Economics: 1 Percent Versus the 99 Percent

The “1 percent versus 99 percent” has become popular rhetoric among Americans who are concerned that such a small percentage of individuals possess such a large share of the nation’s wealth. But this catchy slogan has yet another lesser-known economic implication for those living in the United States.

According to data published by the Agency for Healthcare Research and Quality, in 2009, just 1 percent of the U.S. population accounted for 22 percent of the nation’s total health care costs while 5 percent accounted for almost half of all health care dollars spent. Considering that spending for 2009 was 1.26 trillion dollars, it is a statistic that those concerned about rising health care costs can’t afford to ignore.

The 1 Percent

As one might expect, the elderly contribute substantially to the 1 percent. In many cases, getting old comes with an inevitable increase in the need for health care resources. The old and the sick are, well, old and sick. It is well established that a large percentage of a person’s health care expenditures are typically incurred in the last six months of life. However, when it comes to the 1 percent age isn’t the only factor at play.

[box type=”note”]Also contributing are chronic and preventable diseases, such as diabetes, metabolic syndrome, hypertension, obesity and cardiovascular disease, as well as the cascade of overlapping conditions associated with these diseases over time.[/box]

Anyone who has worked as a health care practitioner has experienced the 1 percent. These are the patients with the never-ending list of compounding health problems. They are the same patients that routinely fall through the cracks of a managed care system that doesn’t adequately address complex health problems.

Many of these patients suffer from conditions that would benefit from comprehensive multifaceted approaches; whole-body lifestyle interventions that recognize the complex nature of chronic diseases yet that aren’t widely accessible in today’s westernized culture of fast-food profit-driven medicine. Addressing the 1 percent requires a system that focuses on preventing sickness and promoting total wellness rather than on treating diseases and individual body parts.

The Solution Versus the Reality

Robust and reimbursable wellness and prevention programs that emphasize healthy eating, regular exercise and healthy lifestyles in general could vastly reduce the impact of these costly conditions while improving the quality of life. Most experts agree preventing a disease makes more sense than treating it.

Yet even as experts tout the importance of prevention, the dominant system in place fails to make it a focus. Instead of investing in a system capable of tackling the underlying and often controllable factors that contribute to these complex problems, it is easier (and more profitable for some) in the short-term to force these increasingly round patients through a square system that continues to treat rather than prevent disease.

It is easier to prescribe expensive drugs, to refer these patients to high-dollar specialists for costly procedures or, perhaps the most unthinkable alternative, to eventually deny care simply because an individual has become too expensive to treat. It is easier to debate the politics of health care and quibble over who should pay than it is to promote a healthcare system that works for everyone, but especially the 1 percent. Like the 1 percent, the U.S. healthcare system is chronically ill and the cure isn’t going to be found by simply treating the symptoms.

The Challenge

So how will countries like the U.S. effectively address the 1 percent? That is the 1.26 trillion dollar question that needs to be answered and soon. Given the recent epidemic of complicated and costly chronic diseases like diabetes, obesity and metabolic syndrome, the “1 percent versus the 99 percent” is more than a memorable catchphrase. It is a reality that threatens to become even more real and economically relevant in the very near future.


Shaun received a Bachelor's of Science in Nutritional Science with minors in Chemistry and Biology from the University of Delaware in 1994 and then completed a Professional Master's in Physical Therapy also from the University of Delaware in 1997. Shaun has worked as an aerobic/group fitness instructor, a personal trainer, a massage therapist, an out-patient orthopedic physical therapist and a consultant for an international credentialing agency that evaluates the educational documents of physical therapists educated overseas. She is an active advisory board member for the Delaware Academy of Massage and Bodyworks, has taught continuing education for massage therapy practitioners and is a course instructor for W.I.T.S. (World International Training Schools) personal trainer certification course. She also writes online fitness and nutrition articles for LIVESTRONG and LIVESTRONG Nutrition and runs a blog titled, Fitness for Smart People.

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