I’m sure you have witnessed a variety of conversations about America’s healthcare crisis, I certainly have. I spent a whole semester senior year studying our disheveled system in Fundamental Issue of Medicine, Health, and Society. I heard presentations from health economists, alternative medicine practitioners and read several informative books on what I assume is only the beginning of our country’s problems with healthcare. The more information I consumed, the foggier my mind got. Insurance methods seem anything but consistent, Medicaid has so many restrictions that only a certified Medicaid specialist could really know what’s allowed and what’s not, and everyone seems to want to blame someone else for our problems.

My very first paper in Fundamental Issues was based on the book “Mama Might Be Better Off Dead,” which highlighted the foes of our current healthcare system, and asked the question “Who’s to blame for America’s healthcare problems?” I dwelled on this question for days trying to figure out who’s to blame. I literally put the paper off until the very last minute, starting my very first paragraph (with no direction at all) at 9pm the night before it was due. All I could think was “who’s to blame, who’s to blame, who’s to blame” when luckily about an hour into it my head cleared… “if only it were that simple.” Obviously it’s not simple at all… that’s the whole point. There is no easy answer to the question “Who’s to blame?”

There are a lot of people and things at fault for where our system stands today, however I have whittled the answer down to four easily identifiable entities within the healthcare arena.

So for your reading pleasure here is who I think is to blame for our current healthcare problems.

1.) Individuals

A certain level of responsibility rests in the hands of each individual. People must learn to value good health and strive toward achieving healthy states. Though some personal choices unavoidably correlate with socioeconomic status such as food availability and exercise, decisions to add extra salt to food, drink alcohol in excess and continue to smoke do not. These habits can be altered and controlled by the individual. Additional factors such as compliance and communication influence personal responsibility.

However, personal accountability for one’s own health represents a convoluted American ideal. The medical system embodies a stigma that holds individuals morally responsible for getting sick and seemingly ignores the compounding socioeconomic problems. Yet, the importance of personal accountability cannot be dismissed or blamed on some other aspect of the system. Refusing to wear a brace, not taking medications due to undesirable yet manageable side effects, and failing to get children immunized are not choices complicated by socioeconomic problems of the medical systems themselves. Rather they represent choices in the domain of personal responsibility that could have positively influenced an individual’s health had decisions to comply with medical advice been made.

2.) Physicians and Health Practitioners

The basic concept that doctors should provide their patient with complete, competent, and consistent medical care dominates societal aspirations for the profession. Unfortunately this is easier said than done for many doctors. There still seems to be no consistent system in place for following up with patients. Many people still receive care from doctors that are poor communicators, who fail time and time again to address the true extent of their patients problems (Don’t believe me? Read some of the true stories out there such as “Mama Might Be Better Off Dead” and “The Social Medicine Reader”). Typically it’s hard to ignore a doctor’s direct responsibility for the level of care they provide their patients.

Additionally, doctors need to stand up and address issues regarding the difficulty of providing complete care for their patients in such a patchwork system of healthcare options. Doctors hold a large amount of knowledge and power in American society. This fact just further elevates the responsibility doctors should take for the care they provide their patients, the manner in which they use their knowledge, and their power to offer patients the most effective care available.

Wonder who else is to blame? Check back, I’ll be sure to let you know…