Occam Sock'em

  • by: |
  • 01/13/2012

Why did Willy Sutton rob banks? “That’s where the money is.” This apocryphal aphorism led to what is called “Sutton's Law,” that when diagnosing, one should first consider the obvious.

President Obama and Medicare directors nationwide should pay heed.  If we want to lower health care costs (or, more honestly, health care spending), we need to look at where the spending takes place. It’s a classic case of Occam’s razor.

According to the Agency for Healthcare Research and Quality (AHRQ), the top 1 percent of health care spenders is responsible for more than 20 percent of all health care spending. And the bottom 50 percent represent only 2.9 percent of the nation's health care bill.

And while this is not news, it seldom seems news fit to print.  After all, it just doesn’t justify a lot of political agendas and editorial opinions that prefer a simplistic, one-size-fits-all single payer national healthcare “solution.”

The National Journal opines, “The data suggest that health care policies designed to reduce spending of healthy populations may be of limited value in reducing overall costs. The big savings can be achieved by reducing the costs of the biggest health care users.”

Entia non sunt multiplicanda praeter necessitatem.

This raises an important question, why didn’t Florida maintain its  “Healthy State” program where high-cost Medicaid recipient care was being managed and overall costs were going down? And why aren’t more states aggressively pursuing solutions like the Hoosier State’s “Healthy Indiana” program, where Governor Daniels made personal responsibility central? Instead public and private payers continue to rely on population-based approaches when science and data – and best practice -- suggest that what we require are more personalized and preventative approaches.

To address the 800-pound gorilla in the room, it also demands a thoughtful national dialogue on end of life care. (77% of Medicare decedents’ expenditures occur in the last year of life – 52% in the last two months of life and 40% in the last month.)

And what better time to raise this issue than during a Presidential election cycle.


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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