How can we move ahead in health care without recognizing that just a few people are burdening everyone with enormous costs?
A new book “At The Crossroads: The Future of Health Care in Vermont” by C. Hogan, D. Richter and T. Doran goes a long way to clarifying the conceptual confusion and pointing the way to meaningful reform. One of the authors’ central insights can be encapsulated in a number. They point out that about 70% of health care costs represent costs of infrastructure. By infrastructure, they mean the hospitals, clinics and personnel that are always available to us whether we are using them at a given moment or not. It is important to address the costs of pharmaceuticals and other supplies, but they only account for about 16 % of health care costs. Reforming the health care system means taking a look at how we finance the health infrastructure. The authors refer to this infrastructure as a “shared service.” It is a service we expect to be on call for us whenever we are in need. It so happens that about 10 % of Vermonters account for about 70% of health care spending. And yet it would be impossible
