Let’s be honest: while high prices, wait times, and red tape do create real burdens for millions of Americans, they are symptoms—not the root cause—of our health care system’s deeper failure. Those are symptoms. The underlying disease? A system of incentives so backwards, it pays for illness and penalizes wellness. In short, we reward failure.
Doctors don’t get paid to keep you healthy. They get paid when you show up sick. It’s called fee-for-service, and it dominates the landscape. If you come in with high blood pressure, you generate revenue. If you fix your health with diet and exercise? That’s a financial loss. It’s not about bad doctors—it’s about bad incentives. The system makes illness profitable and prevention expensive.
Now here’s the kicker: we could change this. Take the Geisinger Health System in Pennsylvania, for example—they’ve piloted models where physicians receive bonuses for improved patient outcomes, like reduced hospital readmissions and better management of chronic conditions. The result? Healthier patients, lower costs, and a blueprint for broader reform. We could build a system where doctors earn bonuses when your numbers improve, where outcomes—not just procedures—drive revenue. There are small programs doing just that. Accountable Care Organizations. Direct Primary Care. They’re proof of concept. But they’re exceptions—outliers in a system stuck in the past. The ACA should be amended to make these outcome-based models the rule, not the exception, encouraging broader adoption of practices that prioritize patient wellness over procedure volume.. Washington, as usual, is the problem, not the solution.
Thanks to the Affordable Care Act (ACA), insurance companies can’t offer lower premiums to people who take care of themselves. A marathon runner pays the same as someone parked on the couch with a bag of chips. That’s not fairness—that’s lunacy. We’ve outlawed personal responsibility from the equation and then wondered why premiums are skyrocketing. Spoiler alert: they’ve jumped over 50% since the ACA passed.
President Obama said, “If you like your doctor, you can keep your doctor.” Millions learned the hard way that wasn’t true. That promise wasn’t just broken—it was shattered. Networks shrank. Plans disappeared. Trust eroded. The ACA centralized control, stripped out choice, and handcuffed innovation. And the result? Rising costs, reduced access, and a system that favors bureaucracy over people.
Critics say adjusting premiums based on behavior would “punish the unhealthy.” But the current system already punishes everyone. Responsible patients subsidize those who don’t lift a finger, and taxpayers bail out the system when chronic conditions spiral into crises. This is socialism in a lab coat—central planning disguised as compassion.
We need a new direction—one that reflects free-market principles and respects the dignity of individual effort. Let insurers compete on wellness incentives. Let providers profit from outcomes, not just activity. Tear down the regulatory roadblocks and unleash American innovation.
We don’t have a health care system. We have a sick-care machine—one that waits for you to break down before it kicks into gear. Contrast that with systems that prioritize wellness, where routine checkups, preventive screenings, and lifestyle coaching are incentivized and rewarded. In those models, health care begins long before a crisis hits. It’s time to flip the incentives, reward responsibility, and restore choice. Let’s get back to what works: markets, accountability, and freedom. Because when people have skin in the game, and providers have a reason to keep us healthy, that’s when real reform begins.