With the topic of peak class polarization once again permeating the airwaves and clogging up NSA servers, and terms like 1% this or that being thrown around for political punchlines and other talking points, one aspect where social inequality has gotten less prominence, yet where the spread between the "1%" and everyone else is perhaps most substantial is in realm of healthcare spending: perhaps the biggest threat to the long-term sustainability of the US debt picture and economy in general. The numbers are stunning.

According to the latest data compiled by the Agency for Healthcare Research and Quality, in 2010, just 1% of the population accounted for a whopping 21.4% of total health care expenditures with an annual mean expenditure of $87,570. Just below them, 5% of the population accounted for nearly 50% of all healthcare spending. Just as stunning is the "other" side: the lower 50 percent of the population ranked by their expenditures accounted for only 2.8% of the total for 2009 and 2010 respectively. Perhaps in addition to bashing the "1%" of wealth holders, a relatively straightforward and justified exercise in the current political climate, it is time for public attention to also turn to the chronic 1% (and 5%)-ers who are the primary issue when it comes to the debt-funding needed to preserve the US welfare state.

The spending distribution in chart format:

Broken down by age - While the elderly represented 13.3 percent of the overall population, they represented 47.9 percent of those individuals who remained in the top decile of spenders:

Broken down by sex - While women represented 50.9 percent of the overall population, they represented 61.6 percent of those individuals who remained in the top decile of spenders:



Broken down by race and ethnicity - Individuals identified as Hispanic and black non-Hispanic single race were disproportionately represented among the population that remained in the lower half of the distribution based on health care spending:



More of the report's findings:

In 2009, 1 percent of the population accounted for 21.8 percent of total health care expenditures and 20.5 percent of the population in the top 1 percent retained this ranking in 2009. The bottom half of the expenditure distribution accounted for 2.9 percent of spending in 2009; about three out of four individuals in the bottom 50 percent retained this ranking in 2010.

Those who were in the top decile of spenders in both 2009 and 2010 differed by age, race/ethnicity, sex, health status, and insurance coverage (for those under 65) from those who were in the lower half in both years.

Those in bottom half of health care spenders were more likely to report excellent health status, while those in the top decile of spenders were more likely to be in fair or poor health relative to the overall population.

While 15 percent of persons under age 65 were uninsured for all of 2010, the full year uninsured comprised 26.1 percent of those in the bottom half of spenders for both 2009 and 2010. Only 3.4 percent of those under age 65 who remained in the top decile of spenders in both years were uninsured for all of 2010.

Relative to the overall population, those who remained in the top decile of spenders were more likely to be in fair or poor health, elderly, female, non-Hispanic whites and those with public only coverage. Those who remained in the bottom half of spenders were more likely to be in excellent health, children and young adults, men, Hispanics, and the uninsured.

And the full report.

In 2009, 1 percent of the population accounted for 21.8 percent of total health care expenditures, and in 2010, the top 1 percent accounted for 21.4 percent of total expenditures with an annual mean expenditure of $87,570. The lower 50 percent of the population ranked by their expenditures accounted for only 2.9 percent and 2.8 percent of the total for 2009 and 2010 respectively. Of those individuals ranked at the top 1 percent of the health care expenditure distribution in 2009 (with a mean expenditure of $90,061), 20.5 percent maintained this ranking with respect to their 2010 health care expenditures.



In both 2009 and 2010, the top 5 percent of the population accounted for nearly 50 percent of health care expenditures. Among those individuals ranked in the top 5 percent of the health care expenditure distribution in 2009 (with a mean expenditure of $40,682), approximately 34 percent retained this ranking with respect to their 2010 health care expenditures. Similarly, the top 10 percent of the population accounted for 65.2 percent of overall health care expenditures in 2009 (with a mean expenditure of $26,767), and 39.7 percent of this subgroup retained this top decile ranking with respect to their 2010 health care expenditures. The data also indicate that a small percentage of the individuals in the top percentiles in 2009 and 2010 had expenditures for only one year because they died, were institutionalized, or were otherwise ineligible for the survey in the subsequent year.



In both 2009 and 2010, the top 30 percent of the population accounted for nearly 90 percent of health care expenditures. Among those individuals ranked in the top 30 percent of the health care expenditure distribution in 2009, 62.6 percent retained this ranking with respect to their 2010 health care expenditures (figure 1). Furthermore, individuals ranked in the top half of the health care expenditure distribution in 2009 accounted for 97 percent of all health care expenditures. Among this population subgroup, 74.9 percent maintained this ranking in 2010. Alternatively, individuals ranked in the bottom half of the health care expenditure distribution accounted for only 2.9 percent of medical expenditures (with a mean expenditure of $236 in 2009). Similar to the experience of the top half of the population based on their medical expenditure rankings, 73.9 percent of those in the lower half of the expenditure distribution retained this classification in 2010.

Given the high concentration of medical expenditures incurred by the top decile of the population ranked by health care spending (65.2 percent), identifying the characteristics of those individuals exhibiting significant reductions in health care spending in a subsequent year is also of interest. Among those ranked in the top decile in 2009 based on their high level of medical expenditures, 29 percent shifted to a ranking in the lower 75 percent of the expenditure distribution in 2010 (data not shown). Individuals ranked in the lower 75 percent of health care spending accounted for only 13.6 percent of all medical expenditures in 2010.



Individuals who were between the ages of 45 and 64 and the elderly (65 and older) were disproportionately represented among the population that remained in the top decile of spenders for both 2009 and 2010. While the elderly represented 13.3 percent of the overall population, they represented 47.9 percent of those individuals who remained in the top decile of spenders. For those individuals who remained in the lower half of the distribution based on health care expenditures over the two-year span, the elderly represented only 3.1 percent of the population. Alternatively, children (0-17) and young adults (18-29) were disproportionately represented among the population that remained in the bottom half of spenders (32.4 percent and 23.5 percent, respectively). In contrast, children and young adults represented only 2.1 percent and 2.9 percent, respectively, of those individuals who remained in the top decile of spenders. Individuals in the top decile ordered by medical expenditures in 2009 that shifted below the first quartile in 2010 were predominantly between the ages of 30 and 64.



Individuals identified as Hispanic and black non-Hispanic single race were disproportionately represented among the population that remained in the lower half of the distribution based on health care spending. While Hispanics represented 16.3 percent of the overall population in 2010, they represented 24.8 percent of those individuals who remained in the bottom 50 percent of spenders (figure 3). For those individuals who remained in the top decile of spenders, Hispanics represented only 6.0 percent of the population. Individuals in the top decile ordered by medical expenditures in 2009 that shifted below the first quartile in 2010 were more likely to be non-Hispanic whites and other races (74.9 percent) relative to their representation in the overall population (66.6 percent).



Individuals who remained in the top decile of spenders in 2009 and 2010 also differed significantly by sex, compared with those who remained in the lower half of the distribution ranked by medical care expenditures. While women represented 50.9 percent of the overall population, they represented 61.6 percent of those individuals who remained in the top decile of spenders (figure 4). For those individuals who remained in the lower half of the distribution based on health care expenditures over the two-year span, women represented only 43.3 percent of the population. Alternatively, men were disproportionately represented among the population that remained in the bottom half of spenders (56.7 percent). In contrast, men represented only 38.4 percent of those individuals who remained in the top decile of spenders. Individuals in the top decile ordered by medical expenditures in 2009 that shifted below the first quartile in 2010 were predominantly female (58.3 percent).



Health status was a particularly salient factor that distinguished those individuals who remained in the top decile of spenders. Overall, 2.8 percent of the population was reported to be in poor health in 2010, and another 7.8 percent was classified in fair health (figure 5). In contrast, of those individuals who remained in the top decile of spenders, 20.2 percent were in poor health and another 26.7 percent were in fair health. Furthermore, for those individuals remaining in the bottom half of spenders, only 0.5 percent were reported to be in poor health and 4.1 percent in fair health. Individuals in excellent health were disproportionately represented among those who remained in the lower half of spenders both years (41.2 percent). Alternatively, for those individuals remaining in the top decile of spenders, only 5.2 percent were reported to be in excellent health and 14.5 percent in very good health. Individuals in the top decile ordered by medical expenditures in 2009 that shifted below the top quartile in 2010 were predominantly in excellent, very good, or good health (25.8, 34.8, and 23.2 percent, respectively).



Focusing on the under age 65 population, health insurance coverage status also distinguished individuals who remained in the top decile of spenders from their counterparts in the lower half of the distribution. Individuals who were uninsured for all of calendar year 2010 were disproportionately represented among the population that remained in the lower half of the distribution based on health care spending. While 15 percent of the overall population under age 65 was uninsured for all of 2010, the full year uninsured comprised 26.1 percent of all individuals remaining in the bottom half of spenders (figure 6). Alternatively, only 3.4 percent of those under age 65 who remained in the top decile of spenders were uninsured. In addition, while 17.9 percent of the overall population under age 65 had public-only coverage for all of 2009, 32.6 percent of those who remained in the top decile of spenders had public-only coverage.



With respect to poverty status classifications, 36.2 percent of the overall population resided in families or single-person households with high incomes in 2010 (figure 7) and 15.2 percent had incomes at or below the poverty threshold. A lower representation of high income individuals (26.6 percent) and a higher representation of the poor (19.3 percent) were observed among those who remained in the lower half of spenders in both 2009 to 2010.

Source: The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2009-2010