Are You A Defeatist, Catastropist, or a Triumphalist?

In a post by Atul Gawande, he talks about “Seeing Spots“.  It’s an interesting piece on the generalized reactions to focusing care on those that really drive the costs in our system. 

It’s an important issue.  If 5% drive 60% of our costs, why wouldn’t you treat them differently.  If 1% drives 40% of the costs (or whatever the number is), shouldn’t you be driving out to their house and helping them. 

Of course it’s not a scalable model to the entire population, but 50% success with 5% of the population would save us 30% per year (not accounting for regression to the mean).  But, it would be meaningful. 

So…which are you?