Why is U.S. Healthcare So 
Damn Expensive?

By Dr. Brian Dixon

|Sep 12, 2018

Recently, I read an unsettling article entitled “Born in the USA” by Dr. Simon Haeder.

In it, Dr. Haeder chronicles how costly and confusing it was for his family to have a baby in the U.S. healthcare system—and he’s a health policy expert! While the article shows how his family went the extra mile to avoid unnecessary costs, the final price tag was still astronomical compared to what it would be in other developed countries.

I won’t be the first or last person to comment about the challenging state of our current healthcare system. It’s confusing. It’s super expensive.

But as a health practitioner, it’s my conviction that it doesn't have to be.

Then, you might ask, why is the U.S. healthcare system so damn expensive?!

I’ll do my best to answer that, as well as a few other questions I commonly receive about U.S. healthcare. Here goes:

1. Why is healthcare so expensive in the U.S.?

High costs in healthcare aren’t necessary because they aren’t universal. If you compare country to country, we are using many of the exact same medicines as other developed countries, and yet we often pay a lot more for an equivalent level of care.

The sad part is, it’s not just one problem that needs fixing.

In fact, it’s several: Our options have become muddled, financial transparency among medical providers has all-but disappeared, and direct physician to patient care has been interrupted by companies who put their financial interests ahead of patient wellbeing. Also, we’ve primed the healthcare industry to prioritize sick-care over preventative care.

Take a deep breath. That was a lot to take in.

The remaining questions will help you realize changes that can be made today to offset those high costs while changing the expensive nature of the healthcare system altogether. (Sounds ambitious, I know, but I believe in you.)

2. How can we change the healthcare system if it’s already such a mess?

We must prioritize structural changes, which involve voting in elections (and voting with your dollars). The healthcare industry has become so confusing that sometimes it can feel like we don’t, as patients, have options about our physicians, medicines, and so on. But it’s not true.

Hospitals are hesitant to release their rates for various medications, operations, and general care, which makes it hard to know your options. But it doesn’t make it impossible. With some due-diligence, learn what private physicians charge for their time and then vote with your money by actively going to the doctors and hospitals who give you the most value for your dollar.

3. Is healthcare a right or a privilege?

I think this question is really asking: If healthcare is so impossibly expensive, who should be made to pay for it? I understand that this question is highly controversial and partisan, but bear with me.

I think it’s most helpful to see basic preventative care as a right and sick care as a privilege. With that said, I still don’t think a privilege has to be unaffordable.

Universal sick care isn’t a right because we need to keep some skin in the game to incentivize staying healthy and NOT getting sick.

As it is, 75-85% of morbidity comes directly from our lifestyle choices. In other words, we cause most of our health problems by our personal health decisions: what we eat, how often we exercise, whether we smoke, etc.

That number isn’t going to get any better if we take even less responsibility for our life choices. The current focus of our healthcare system—sick care—needs to be challenged and changed. Imagine the ramifications of a healthcare system driven by preventing diseases instead of just curing them. There’d be far fewer diseases to cure, as well as far lower healthcare costs to worry about.

Tim Ferriss sums up the problem of half-heartedly caring about our personal health: “Making health #1 50% of the time doesn’t work. It’s absolute—all or nothing. If it’s #1 50% of the time, you’ll compromise precisely when it’s most important.”


Start today. Prioritize preventative care over restorative care. Alleviating disease, fatigue, stress, and other unhealthy influences on our bodies is the lowest-cost way of providing ourselves affordable health coverage.

4. Why can’t healthcare be a direct exchange between patient and physician?

It used to be. The old healthcare model involved a patient visiting a physician, who would deliver an educated guess as to problems and solutions. Then the patient would pay the physician and the interaction was over. So why can’t it be like that today?

Somewhere down the line, other organizations entered the conversation including: hospitals, government, insurance companies, HIPAA, pharmaceutical companies, lawyers, the VA, and risk pools.

All these entities contribute to excessive spending and waste, but more importantly, they become unnecessary members of a conversation that should be exclusively between the patient and physician.

5. So how do I find the best value for my dollar?

We’ve discussed some practical ways to lower your healthcare costs through preventative self-care. There’s more you can do.

As I’ve pointed out, the wrong people and businesses are calling the most important shots about everyone else’s healthcare. What if it was possible to reshape the entire healthcare system and put your most pressing healthcare needs back into focus, instead of jumping through all the current hoops? I don’t mean incremental changes—I mean totally flipping this industry on its head.

I think transforming our healthcare system—including lowering its high costs—is simpler than it sounds. It starts by putting money in people’s pockets so they can be empowered to pay for their own healthcare.

That’s why I advocate for creating 50 separate nonprofit companies for each state where every individual over 18 years of age is a shareholder in the company who pays a “general health fee.” Basically, like a Costco membership.

Each state’s nonprofit would be able to drive down costs by changing the market forces at play. The democratically-elected board of directors for each state would be able to buy equipment and medications from other countries or states for instance, increasing competition and reducing costs for everyone.

“People value what they pay for and pay for what they value. When everyone has skin in the game, they have a vested interest in keeping costs down by staying healthy because it keeps money in their pockets.” - Me, in my book about transforming healthcare (page 59, shameless plug).

To see my full plan, watch this short video about the 6 steps to reforming U.S. healthcare. In it, I address common sense, simple, sustainable (and shockingly bipartisan) solutions that benefit both individuals and healthcare professionals.

And hint: It’s not about insurance.

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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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