Today is soapbox day. I am compelled to stand on the digital soapbox and talk about “personal responsibility.” Among legislators, administrators, commentators, and policy wonks, when the conversation turns to problems in our health care system and the need for health reform, suddenly the conversation is inundated with exhortations of “personal responsibility.” It sounds something like this, “If people would stop smoking, eat less, drink less, get off the couch and exercise more, then they would be healthier and the cost of health care would go down.” Who can argue with that? The implication is this: if people get sick and need health care, it is probably their own fault because they did not take “personal responsibility.” The problem is not in the system, it is in individuals.
Yes and no. In fact, I would say mostly no. Here is an analogy. Someone is driving around town and they accidentally crash their car into a light post. Why did they crash? One could argue that they failed to take “personal responsibility” for safe driving. Blame assigned. Problem solved. No need to look further.
However, if we do decide to investigate a little more carefully, the tidy little blame-the-victim package starts to unravel. Did the car have a manufacturing defect or a faulty repair that contributed to the crash? Were the tires properly manufactured? Was the intersection properly deiced and sanded? Did a child or a drunk dash out in front of the car? Did another person run a red light? Was the intersection properly designed and maintained? Was there a huge pothole due to a lack of funding for adequate road maintenance, or a chunk of metal debris in the street?
Did legislators exercise their “governing responsibility” by allocating sufficient funds and resources for construction, repairs, and maintenance of safe roads? Did they enact sufficiently strong policies to restrict cell phone usage among drivers, and to restrict the sale and use of alcohol, particularly by drivers? Have the schools taken “educational responsibility” for promoting a culture of safe driving among their students and staff? Do automobile manufacturers exercise “manufacturers’ responsibility” by spending billions of dollars a year to promote a culture of fast, high risk driving to sell more cars? Do fast food retailers assume “food vendors’ responsibility” when they spend billions researching and advertising foods drivers are most likely to buy and eat while driving, despite the known hazards?
Was it just a matter of “personal responsibility,” and how far does that perspective get us in understanding the social, cultural, political, and commercial contributions to the collision?
Back to “personal responsibility” in health issues. An individual buys a pack and lights up a cigarette. One way to look at it is that it is a matter of “personal responsibility.” However, billions of dollars a year are spent in research and marketing backed by legions of industrial psychologists and sociologists and pharmacologists who have one goal in mind: to make sure that people will purchase and smoke cigarettes, and that they will do it daily, decade after decade. The whole point of this massive effort is to subvert “personal responsibility.”
Food manufacturers research, produce, and package sugary, salty, fatty foods with long shelf lives to be profitably sold by mini-marts, gas stations, and fast food outlets that have proliferated on every corner across the nation. All media are saturated with billions of dollars of scientifically engineered advertising designed to encourage endless consumption of these commodities. The targeted and desired result of these efforts is to extinguish the vestigial role of “personal responsibility” in the consumption of food.
The health insurance industry maximizes profits by selling health insurance to healthier populations who are less likely to use it, denying health insurance to those who are more likely to use it, denying the claims of the desperately ill who do use it, and selling “high deductible” health insurance policies to low-income families who will be forced into bankruptcy before they ever see the first health insurance dollar. In this commercial environment the role of “personal responsibility” is largely irrelevant.
The concept of “personal responsibility” in the absence of a discussion about the responsibility of government, industry, the regulatory agencies, and elected officials is a diversion from serious analysis. Everyone needs access to high quality health care. Sound public policies based in socio-economic analysis can get us there. Jumping to the blame-the-victim ideology of “personal responsibility” will not.