Make U.S. Healthcare Affordable Again: Reward Personal Responsibility

By Dr. Brian Dixon

|Jan 18, 2019


I was raised with four siblings under the tutelage of a strong single Momma. Since television time hinged on every sibling’s participation in daily household chores, my day had a 80% chance of being ruined by the actions of someone else.

I grew up in the 80's and 90's when we watched television live, complete with commercial breaks and all. Streaming and pausing were luxuries of the future. Watching new episodes of MacGyver and Dynasty were wholly dependent on all 5 of us cleaning the house, washing the dishes, and using our manners. If one kid messed that up—my twin brother was almost always the culprit—it could prove disastrous for the rest of us.

As a result, the 5 of us watched our tone, learned to compromise, and individually sacrificed for the greater good. If only healthcare worked that way.

Personal vs. group responsibility in healthcare

When we use the word “healthcare” many of us probably envision insurance premiums, network-approved doctor’s offices, or taking medicine—an occasional step to restore some element of our health. Instead, “healthcare” should make us picture regular exercise, good eating habits, and working directly with our physicians.

The real problem I’m dancing around is: people are disconnected from their personal health and our current system reinforces it.

When there’s no incentive to live healthily, many people ignore their health until they have to respond to a crisis. That’s why group responsibility for healthcare isn’t better for the individual or the collective health of our country.

Returning to my childhood metaphor: We—Americans—are currently locked into risk pools and insurance policies that allow our "siblings" to run amok: smoking, eating poorly, remaining sedentary, and engaging in other risk-taking behaviors.

These actions drive up the costs for each and everyone of us. That’s just how it is in our post-ACA common life. You couldn’t get out if you tried. Not anymore than I could have turned on the TV without my mother’s consent—that would have been trouble!

Now, my family is grown, each adult independent and responsible for themselves and their livelihoods. We need a healthcare finance system that does the same: allow individuals to own the results of their actions.

We won't have Obama to blame or Trump to ridicule for the outcomes of our health decisions. (Read my book and learn how to ignore them.) We only have ourselves to blame.

No more relying on Democrats or Republicans to reach an agreement on funding healthcare; instead you'll do it yourself. How novel. That's the definition of freedom: the ability to make choices that work best for you and manage the consequences of those actions. Let's stop fighting and start changing.

Before we go any further: I’m not against group-sponsored healthcare.

The reason this group practice doesn’t work in our current American healthcare system is because we’ve focused on health insurance instead of healthcare.

Think about it. You pay a monthly premium that, whether you get sick or not, is going into the pocket of a business. What incentive do you have to stay healthy? You’ve paid your dues in cold, hard-earned cash. The return: the insurance company’s weak promise to consider helping you when you eventually need it.

It would be like behaving good all day long, doing all my daily chores, and then finding out we all get to watch TV no matter what. Inevitably the house would get messy and stay messy, even if I continued to do my share of the chores.

If we want group methods to work, we must incentivize being healthy in the same way my Momma incentivized our good behavior. Taking personal responsibility for staying healthy must directly correlate with our spending.

Is group healthcare possible without insurance?

Let’s consider an example. You pay a monthly healthcare premium—notice I didn’t say insurance premium—giving you access to discounted medicine, any doctor you like, and more. At the end of the year, if you remained mostly healthy, that money you spent every month on your premium reverts straight back to you.

Some of us might change our lifestyle because our personal responsibility gets directly rewarded.

As a kid, our reward was getting to watch TV if we were good. As adults, our reward should be affordable healthcare if we can work together to take care of ourselves.

For too long, tricky marketing tactics in a hyper consumer-driven society have told us that we can have our cake and eat it too. We can’t. We must take care of our bodies, quit smoking to protect our lungs and cardiovascular system, avoid processed foods and excessive sugar for our digestive system, and get exercise to support our brain and bone health. We’ve all gotta do it.

As a society, we must work together to reinforce these good habits for the good of us all.

Want to learn more about my plan to make U.S. healthcare affordable again? I made a video showing how group-subsidized healthcare could work on the state level—if only we skip those damned insurance companies. Learn more here.

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About the author

Dr. Brian J. Dixon

With accolades spanning my career as a child psychiatrist, entrepreneur, writer, and public speaker, I advocate for a more sensible U.S. healthcare solution that appeals across all party lines. I am a Texan, born and raised. My psychiatry practice, Progressive Psychiatry, is based in Fort Worth.

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