Generally, the work ethic in America is at low tide. Few American workers, on any level, care much about the quality of services and goods they provide—except as mandated by laws and regulations and strictly enforced in penalties. Most workers work for the paycheck alone—well, the paycheck and other perks of the job—not out of any sense of mission, calling, or personal satisfaction in work well done. As a rule, American workers feel no loyalty to either their employers or their clients and customers; further, few feel any loyalty towards their fellow workers.
The insurance industry has a suffocating grip on health care. Patients buy expensive insurance to receive access to health care (by the way, “access to health care” is not the same as “health care”—once access is achieved, there are further payments—often substantial—to be made on deductibles, co-pays, uncovered treatments, etc.), and physicians buy expensive insurance to protect themselves from malpractice suits. Even insurance companies themselves buy expensive insurance from fellow insurance companies. It’s a con—and hardly anything at all is really ensured by possessing insurance—except that everybody pays out mounds of money that winds up in the hands of very few.
Everything has to turn a profit. It’s not enough to provide needed services to the community and reap proportionate benefits that allow you, your friends, your family, and your employees to live at a reasonably high standard. Instead, influence is used to pass laws that benefit corporate interests (not true professionalism, not the public good)—often making legally mandatory certain medical practices and insurance coverage that ultimately benefit hardly anyone but the providers of these “services.” The “caregiver” (often a corporate entity, not an actual human being—another problem with the system) often uses its life-or-death advantage over the ill and the injured to charge gouging prices and to “recommend” unnecessary tests and treatments and follow-ups.
America is a litigious society. We think a lawsuit is the answer to all the deficiencies, inequities, and hardships of life. We cannot accept our own mortality, so that even when the very old or the very reckless among us dies—itself not so extraordinary an eventuality—we look for someone (individual or corporation) to take the blame. Even then, blame is not enough—and the only currently satisfactory recompense requires fistfuls upon fistfuls of cash, disproportionate to the injury, even disproportionate to the value the person had to his or her family, friends, and community in life. (By the way, I’m a firm believer in patients’ and families’ rights to sue for malpractice and neglect—but primarily as a safeguard to individuals’ rights to life and freedom from avoidable harm, not as the pure money game it has become.)
Essential services are outsourced. The compartmentalization of health care, on top of the specialization of the medical profession, has resulted in a disconnect among the various entities that provide “care” for the ill and the injured. Thus, nobody has responsibility for the quality of care given, apart from the recipients themselves. Granted, one should be ultimately responsible for one’s own health care—but the outsourcing of services so fragments the “care” and the “responsibility” that a patient seldom if ever actually meets anyone who takes any responsibility for its quality—thus, the ill and the injured bear the responsibility in its entirety (except where laws—often compromised by “professional” interests, i.e. lobbyists for the legal and medical professions—assign legal responsibility)—even worse, in America the health care (its costs and its Byzantine maze of bureaus and specialties) becomes itself an added burden for the ill and the injured to bear on top of their illnesses and injuries.