That’s the question David Freedman tried to answer in an article in The Atlantic, pointing out that the high cost of the U.S. healthcare system could come down to the patients themselves.

Namely, the actions of American patients––from not following through on their care plans, getting regular checkups or engaging in community wellness––are driving up healthcare costs and would likely drive up spending under the health systems of other comparable nations.

What patients do matters much more than what healthcare providers do, according to experts. Nearly 75% of the variation in life expectancy in the U.S. is explained by lifestyle choices, such as smoking and inactivity, Freedman stated, noting a JAMA Internal Medicine study.

In addition, Americans are often overtreated, he argued, contributing to overall higher costs. When they are treated, American patients have a “flagrant disregard” for routine care and fail to take prescription drugs as prescribed.

“Marveling at what other systems around the world do differently, without considering who they’re doing it for, is madness,” Freedman wrote. “The American healthcare system has problems, yes, but those problems don’t merely harm Americans—they are caused by Americans.”

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