Everyone has a reason.
The budget. The board. The regulators. The incentives. The system.
Often, every explanation is true.
That is what makes the alibi so powerful.
A moral alibi is a true explanation that becomes an excuse.
Healthcare is complicated.
Regulations constrain us.
Organizations need to make money.
Doctors are overwhelmed.
Executives answer to boards.
All true.
The alibi begins when explaining the system becomes a way of escaping responsibility for our own choices.
The system is everyone’s fault.
Which means the system is no one’s fault.
Insurers blame hospitals.
Hospitals blame insurers.
Doctors blame administrators.
Companies blame regulators.
Regulators blame markets.
Everyone points outward.
Everyone has evidence.
Everyone has an alibi. But systems don’t make decisions. People do.
Specific people. In specific rooms. Making specific choices.
The system provides the conditions. The decisions happen anyway.
I know. I have been in those rooms.
I have been a physician. A government official. A healthcare executive. A CEO.
I have spent my career trying to make healthcare better.
I have also helped perpetuate some of the things I believe are wrong with it.
I have made compromises. Accepted explanations. Stayed quiet when I should have spoken. Convinced myself that constraints left me with less choice than I actually had.
This is not an indictment from outside the system. It is a self-indictment from inside it. Good people need alibis. Cynics don’t.
The moral alibi belongs to people who still need to believe they are doing the right thing. It allows us to see what is wrong—and continue doing it.
We have learned the language.
“No margin, no mission.” “Standard industry practice.” “The regulators won’t allow it.” “The board would never approve it.” “Everyone else is doing it.”
“We can’t fix the whole system.”
Maybe.
But those answers avoid a harder question.
What is mine to fix? The system is broken.
There are two ways to finish that sentence.
The system is broken. Therefore I am not responsible.
Or:
The system is broken. I am inside it.
Therefore I am responsible for what I can change.
