Twenty-five per cent of all Medicare spending goes to the five percent of patients in their final year of life, Atul Gawande reported in the New Yorker. And here's a similar figure to stow in your hat: 5% of Medicaid patients consume more than half of all Medicaid spending.

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Like any insurance program, Medicare and Medicaid's heaping costs fall overwhelmingly on the most needy, like the dying and disabled. That's not a bad thing, per se. Focusing on the most needy is what insurance is supposed to do. But it will be impossible to address our health care cost crisis without focusing on these groups. Graph from Kaiser Family Foundation.