The hidden costs of health care are largely in the denial of antifragility. But it may not be just medicine—what we call diseases of civilization result from the attempt by humans to make life comfortable for ourselves against our own interest, since the comfortable is what fragilizes.

Less Is More

For instance, a small number of homeless people cost the states a disproportionate share of the bills, which makes it obvious where to look for the savings. A small number of employees in a corporation cause the most problems, corrupt the general attitude—and vice versa—so getting rid of these is a great solution. A small number of customers generate a large share of the revenues. I get 95 percent of my smear postings from the same three obsessive persons, all representing the same prototypes of failure (one of whom has written, I estimate, close to one hundred thousand words in posts—he needs to write more and more and find more and more stuff to critique in my work and personality to get the same effect). When it comes to health care, Ezekiel Emanuel showed that half the population accounts for less than 3 percent of the costs, with the sickest 10 percent consuming 64 percent of the total pie.

• Nassim Taleb, Antifragile