Health insurance reform isn’t about most of us.

Ten percent of people spend 80% of healthcare dollars. Therefore 90% of people spend only 20%. The vast majority of us are light healthcare users. We may need a couple of office visits a year and maybe we cut our finger and need some stitches. Ninety percent of us don’t require much. 

Controlling health costs only applies to that 10% of the population who are heavy users. The rest of us are what’s called “low hanging fruit.” That’s why cancer centers and cardiology wings are always far nicer than the pediatric wing of the hospital.

Therefore we need two systems:

  1. We need the heavy use system that focuses on chronic disease because 75% of healthcare costs comes from chronic diseases like diabetes.
  2. We need the light user system. This should look and function more like the Apple Store to take care of simple problems like broken arms.

The light user system should focus on the experience and the customer service. The heavy user system should focus on function and creating the most cost-effective way to manage chronic, behavioral-based problems like diabetes, heart failure, and depression.

Right now we’re all wrapped up in one system and we all have the same miserable experience. A broken arm in the ER is next to a diabetic with heart failure. For 90% of people, we could have a kick ass experience.