Both Aaron Carroll at The Incidental Economist and David Phillippe at Punditocracy pointed to a new brief from the National Institute for Health Care Management this month, which found that half of all health care spending in 2009 was concentrated amongst just 5 percent of Americans. Conversely, half of all American health care spenders accounted for just 3 percent of spending.

Not surprisingly, this top 5 percent of spenders is disproportionately represented amongst the sick and the elderly. More importantly, an individual in the top 5 percent generally accounted for something in the neighborhood of $40,000 in health care spending in 2009.

That’s significant because most of the health care reforms suggested by Republicans or conservatives include things like health savings accounts, high-deductible catastrophic coverage plans, allowing insurers to compete across state lines, and the like. These approaches focus on controlling cost by increasing individuals’ price sensitivity to their health care decisions. But for people who must spend $40,000 or more in a single year, “price sensitivity” is largely meaningless — there’s no way for them to grapple with such costs themselves, unless they’re wealthy. When those same people account for half of all health care spending, the possibility of controlling health care costs via the consumer-driven model begin to decrease rapidly. As Carroll sums up:

When we talk about consumer directed health care, we’re talking mostly about healthy people. We don’t want sick people to avoid care. We want to stop healthy people from consuming it. The problem is that healthy people consume so little care to begin with. If we could incentivize the healthier half of people to forego all their personal health care spending, we’d spend $36 billion less out of a total $1.259 trillion in personal health care spending. That would be a drop in the bucket.

Health savings accounts are of little use to anyone amongst the higher spending groups who isn’t independently wealthy, as they will quickly deplete their savings or won’t be able to stock the account in the first place. Competition across state lines will allow insurers to congregate in the state with the most lax regulations and requirements, and thus compete to see who can do the best job of denying coverage to high-risk individuals, rather than competing to see who can deliver the most efficient and effective care. Catastrophic coverage plans tend to divide the pool of young and healthy coverage recipients from the old and sick, leaving the pool of the latter with less incoming funds to deal with greater costs.

Increasing price sensitivity means individualizing risk, by leaving more of the cost of an individual’s care on their own shoulders. Absent a single-payer system, or something along the lines of Obamacare’s framework, it’s hard to see a possible route to controlling costs that doesn’t involve simply pricing large numbers of sick and elderly Americans out of receiving health care entirely. In fact, that’s precisely what the American system has already been doing for some time.

Rep. Mike Kelly (R-PA) today compared a new regulation requiring insurers to provide women birth control without a copay to September 11th or Pearl Harbor.

In a speech on the House floor, Kelly said it was such a travesty that women wouldn’t be paying hundreds of dollars a year in copays that it should go down in history as a great tragedy similar to those two events that killed thousands of Americans:

“I know in your mind you can think of the times America was attacked,” said Rep. Mike Kelly (R-Pa.), a freshman.

“One is December 7 — that is Pearl Harbor Day. Another was September 11 — that was the day of the terrorist attack.

“I want you to remember August 1, 2012 — the attack on our religious freedom. That is a date that will live in infamy, along with those other dates.”

Today marks the beginning of implementation for the birth control mandate, which is a part of Obamacare. It is just one of the many benefits in the law for women. The mandate has been hotly contested, however, by the Catholic church, which considers it an affront to religious freedom, despite the fact that many Catholic institutions already cover birth control, and the church itself wouldn’t be paying for contraception.

Lawmakers like Rep. Paul Ryan (R-WI) and Sen. Ron Wyden (D-WY) support radically restructuring the current the Medicare system into a voucher program that provides seniors with “premium support” credits to purchase coverage from an exchange of private health insurers or remain in traditional fee-for-service Medicare.

Mitt Romney, the GOP presidential candidate, has embraced the idea, which critics have long suspected would increase costs for seniors.

Under the proposal, insurance plans would submit bids for how much they would charge to provide coverage and the voucher “would be tied to the premium of the private plan with the second-lowest cost, or the premium for traditional Medicare—whichever is lower.” Critics charged that in areas where private plans make bids that are lower than the cost of traditional Medicare, seniors would see increase costs and now, a new study finds that had the plan been implemented in 2009, 24 million beneficiares enrolled in the program would have paid higher premiums to maintain their choice of plan and doctors:

Nationally, in 2009, the benchmark plan under the Ryan-Wyden framework (ie, the second-lowest plan) bid an average of 9% below traditional Medicare costs (traditional Medicare was equivalent to approximately the tenth-lowest bid). Since traditional Medicare is simply another plan option under the Ryan-Wyden plan, a beneficiary in 2009 would have paid an average of $64 per month (9% of $717) in additional premiums to stay in traditional Medicare. Across the United States, 68% of traditional Medicare beneficiaries in 2009 (approximately 24 million beneficiaries) lived in counties in which traditional Medicare spending was greater than the second–least expensive plan and would have paid more to keep their choice of coverage (a share that would have been 81% in 2008, 75% in 2007, and 67% in 2006). Furthermore, more than 90% of MA beneficiaries (approximately 6.6 million seniors, excluding those dually eligible or in employer plans) would have also paid more for the plan they chose.

On average, the GOP-backed idea would have resulted in a premium increase of $768 million each year for those 24 million seniors, accounting for 68 percent of beneficiaries.