Just A Flesh Wound

ARTHUR: You are indeed brave, Sir knight, but the fight is mine.
BLACK KNIGHT: Oh, had enough, eh?
ARTHUR: Look, you stupid bastard, you’ve got no arms left.
BLACK KNIGHT: Just a flesh wound. (more)

In the US the top 5% of medical spenders spend an average of $40,682 a year each, and account for 49.5% of all spending. (The bottom half spend an average of $236.) Not too surprisingly, 60.3% of these people are age 55 or older. Perhaps more surprising, on their health self-rating, 28.9% of these folks say they are “good”, 19.9% “very good” and 7.5% “excellent”, for a total of 56.3% with self-rated health of “good” or better (source).

So, are these folks in serious denial, or is most of our medical spending on hardly sick folks?

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  • arne.b

    If the health self-rating is about one’s health _after_ that much money has been spent on it, could the result not just mean that the money was well spent?

  • Lxndr

    I’m a cancer survivor,and am likely in that top 5% (I’m 33 years old, for the record). When I answer those questions, I imagine there’s an invisible “considering…” at the end.

  • jb

    Your parenthetical confused me – are you saying that 53% of the 60% of older folks in the top 5% of medical spenders self-report as ‘in good health’?

    Wouldn’t that be a sign that the expensive medical care is working, and they feel good? Or, like Lxdnr said – they are evaluating on a different scale than a healthy person would? Or, they’re level-resetting, just like everyone else who endures something “unthinkably bad” only to discover that once they’re on the other side, things aren’t so bad after all?

  • I guess that self rated health is not of much practical use.

    They may be thinking relatively.

    A diabetic might say he is in great health as long as he takes his insulin.

    My 89 year old father likes to say he in in great health because he is alive while most people die before 89.

  • WL

    Generally people who aren’t in reasonably good health don’t live much past their early 60s…

  • Mark M

    Perhaps they are good because they’ve spent the money necessary to make them well?

  • Poelmo

    I agree with the previous posters: who says it’s not BECAUSE OF the expensive medical care that they feel so healthy and/or they tend to rate their health relatively?

    Also, I doubt hypochondria is very much in play here: studies in countries with single payer healthcare systems seem to show they’re not really getting drowned in hypochondriacs and I doubt there’s something in the water that makes only old people hypochondriacs in the United States. It reeks of an economically libertarian agenda to start digging deeper when the obvious answer is that old people need healthcare more often because old people tend to get sick more, just like cats, old birds, old fish or pretty much every other animal on this planet.

    • Sigivald

      When Mr. Hanson says Not too surprisingly, 60.3% of these people are age 55 or older he’s not “digging deeper” as to why, he’s acknowledging explicitly that old people tend to be sicker.

      No hidden agenda there (or at least, if there is, it’s undetectable because of that text).

      The surprise, as he says, is that they also rate their own health “good” more often than not; the tension is between what the spending data suggests very strongly about relative health, and the self-reporting.

      And while it’s easy to simply assume they must be deluded about their health (or that it doesn’t matter much since it’s vague, as Mr. Riedel suggests below), the hypotheticals are interesting.

      What if they’re not deluded, in other words?

      • Poelmo

        So, are these folks in serious denial, or is most of our medical spending on hardly sick folks?

        I think that’s a pretty clear sign he is digging deeper. Sure he acknowledges that it may be due to old age, but he also questions this based on pretty much nothing. Nothing wrong with that as long as people are open about their agendas.

  • So, are these folks in serious denial, or is most of our medical spending on hardly sick folks?

    Or maybe asking people how healthy the feel is a worthlessly vague metric?

    • Sigivald

      Or maybe asking people how healthy the feel is a worthlessly vague metric?

      Well, if you’re concerned only with their health-as-such, sure.

      If you’re concerned with their satisfaction result of healthcare spending, it’s completely relevant.

  • This is a little off topic but I always wonder about the variation in lifetime spending link below has that for Canada. Their are a couple of nice charts:


    In order to calculate the distribution of lifetime costs, we estimated the Markov models using Monte Carlo microsimulation trials (Figures ​(Figures44 and ​and5).5). As might be expected, lifetime costs are somewhat less skewed than are per capita costs in any single year. However, the distribution is far from normal; costs are not tightly grouped around the mean. For women, mean lifetime costs are $89,722, with a standard deviation of $38,776. Median costs for women were $86,125. Ten per cent of women incur lifetime costs of less than $43,843. For men, the mean is $64,052 with a standard deviation of $35,331. Median costs for men were $59,819, while 10% of men incurred lifetime costs of less than $22,450.

    Interestingly many people’s lifetime spending is below $20,000 while the chart shows some at $260,000.

    • Poelmo

      “Interestingly many people’s lifetime spending is below $20,000 while the chart shows some at $260,000.”

      Some people get cancer, some don’t, not sure how I can break that down further.

  • Rafal Smigrodzki

    During any particular year, a sick elderly person is likely to feel very sick only a few weeks, and otherwise he is functioning relatively better. Since the self-perceived level of health is expressed not in absolute but in relative terms (compared to a patient’s previous bouts of illness or compared to his sicker cohort members), a survey asking the question at random times is likely to elicit optimistic assessments.

    This interpretation is compatible with both high levels of medical services utilization due to sickness and with absence of high levels of denial in the elderly. On the other hand, it would be hard to make reliable inference regarding the effectiveness of medical care from these data.

  • Wonks Anonymous

    I agree with Floccina that you shouldn’t put much weight on a survey. Per Converse, lots of answers are basically meaningless.

    Poelmo, rates of disability are higher in many european welfare states (particularly Sweden). Rates have also increased in the U.S (for working-age people), even as occupations have gotten safer.

    • Poelmo

      Disability checks are not the same as medical spending. You’re not a hypochondriac when you scam social security (though I’m sure many Americans just do it to get by after their 159th failed job interview, but also in Europe partial disability checks are often provided to plug the hole in social security that is taking care of 50+ year olds who get fired and nobody wants to hire afterwards). The difference is that a hypochondriac has society give money to a doctor on his behalf, while somebody on disability has society give the money to himself.

  • Matt

    The whole issue is a little confusing. My grandpa died at the age of 86. He had three different kinds of cancer. He didn’t go to the hospital until about a week before he died and I’m sure he would have never claimed on a survey that he was unhealthy. I’m not sure how he would have changed as a statistic if he would have gone to the hospital a year earlier, other than he would have spent more money.

  • Dave

    I thought the question of how well one thought one was ,was really not the main point of the article,so great brain power was not exerted on the part of the original author to explain it. That is only occurring here.So it might be a case of much ado about nothing. Also people are naturally optimistic. Also the poll was biased because no dead people were included.

  • A lot of people in this thread are saying that it’s possible the medicine made people healthier. Refuting this claim has been a large part of Robin’s previous posting, e.g. here and here, and is beyond the scope of this two-paragraph blog post.

  • Gary

    Who said it was the same 5% of people every year? Let’s say it was a different 5% each year that got sick. Then they would very reasonably say they are mainly healthy. My kid broke his arm last year and the insurance was billed $17000. If it were anything more serious I’m sure he would have been one of that 5% last year. He’s as healthy as an ox.

    If a simple trip to the hospital costs as much as the average American makes in a year, then those admitted to hospitals each year will be those that made up nearly 50% of medical spending.

    The ones that made up 50% of medical spending might have just been the ones that got sick.

  • Robin is making the ecology fallacy; the idea that the average member of a group has traits characteristic of the average of the group.


  • Ian Maxwell

    I have a sense that, for most sufficiently affluent Westerners, it would be a faux pas to rate oneself as in poor health. You are supposed to be in good health, and you would never admit to anything else in mixed company. These same people usually say they love their jobs, even though their saying so is about the only evidence you can find for that claim.

    • John

      They might not even be lying on that latter point, just twisting a bit. They love being in the condition of having a job, as contrasted with being in the position of having to do the same amount of work looking for a job with nothing to show for it afterward.