Emory Law Journal Volume 69 Issue 6 2020 Expensive Patients, Reinsurance, and the Future of Health Care Reform Govind Persad Follow this and additional works at: https://scholarlycommons.law.emory.edu/elj Recommended Citation Govind Persad, Expensive Patients, Reinsurance, and the Future of Health Care Reform, 69 Emory L. J. 1153 (2020). Available at: https://scholarlycommons.law.emory.edu/elj/vol69/iss6/1 This Article is brought to you for free and open access by the Journals at Emory Law Scholarly Commons. It has been accepted for inclusion in Emory Law Journal by an authorized editor of Emory Law Scholarly Commons. For more information, please contact
[email protected]. PERSAD_8.21.20 8/24/2020 11:43 AM EXPENSIVE PATIENTS, REINSURANCE, AND THE FUTURE OF HEALTH CARE REFORM Govind Persad* ABSTRACT In 2017, Americans spent over $3.4 trillion—nearly 18% of gross domestic product—on health care. This spending is unevenly distributed: Almost a quarter is spent on the costliest 1% of patients, and almost half on the costliest 5%. Most of these patients soon return to a lower percentile, but many continue to incur health care costs in the top percentiles year after year. This Article focuses on the challenges that persistently expensive patients present for health law and policy, and how fairly dividing their medical costs among payers illuminates fundamental normative choices about the design and reform of health insurance. In doing so, this Article draws on bioethical and health policy analyses of the fair distribution of medical costs, and examines how legal doctrine shapes health systems’ options for responding to expensive patients.