Since insurance is for the most part tied to employment someone who is too sick to work is more than likely to be covered on Medicaid.
I’m sure there are dependents of people who work who fall into that category but I would project that 80% of those sickest people are on government assistance.
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Now you're just trying to rationalize. My mom, for example, had esophageal cancer. It was a lengthy ordeal that required chemo, surgery, and a lengthy recovery. By the end of it all her medical bills totaled $2.2 million. All of it was covered by the insurance she got through her employer. But that's just one anecdotal piece of things.
Or is logical to assume that, because most of the sickest people tend to be the oldest, that a vast majority of the sickest people are in government assistance, but it's nowhere near what you think. The government does indeed pay for most of our most sick. Medicare paid 37% of the medical bills for the sickest five percent, while Medicaid pays for just over 10%, so 48%, not quite 80%. Private insurance pays for 46.6%. And 5.4% of the sickest Americans self pay.
The thing is, included in that 5% are the people who are working and have insurance, but something happens that requires high dollar medical care, and not just the older, sicker people with chronic diseases. A nasty staph infection that puts you in the hospital for 4 days (ask me how I know about that one), having a baby, an accident that puts your in the hospital for a few days, an appendectomy, breast cancer, lots of things that happen to working people with insurance. The CDC says as many as 50% off the population have some kind of chronic disease, and many of those involve working people with insurance, like heart disease, arthritis, diabetes.
It's the top 1% that really do the most spending, and those are really, really sick people, usually older and white, a large chunk in their last year of life, or people with, as you say, illnesses so bad they couldn't work regardless.
But none of this is new. It's been the sand 5% for at least my lifetime, and probably for centuries.
