There were no soldiers to throw stones at so my boyhood buddies and I played another dangerous game called Rush ‘n’ Muck. It was free-for-all football; the guy with the ball tried to make a touchdown while every other player tried to crush the ball carrier and get the ball for himself (it was all boys – the girls were not dumb enough to play). There were no teams, only the kid with the ball suddenly a target for a bunch of adolescent smart bombs on legs.

Health care is like that these days, only the ball is the health care dollar. Players are patients, business employers, doctors, health insurance companies, pharmaceutical companies, hospitals and government, etc. With no alternative in the current system, the game has little to do with cutting total health care costs; it is only about getting and saving the dollars each player needs to survive by taking those dollars from someone else in the game. Clotheslining the opposition in order to score is no problem.

The job of holding down health care costs in this country belongs to none of those players individually or collectively. There is no one in America these days whose job it is to make healthcare less expensive for all of us, and plenty of people whose job it is to make health care less expensive for themselves, if necessary by shifting their costs somewhere else.

Take the federal government, for example. One would think that, with the rising cost of health care being a priority issue for all Americans, the federal government would be doing its best to help hold down health care costs. One would think there would be a Department of Defense Against Soaring Health Care Costs. Sorry, no. In fact, if you called every federal agency in America and asked to talk to the person whose job it was to hold down American health care costs, you would probably end up with President George W. Bush on the line and he would just say, “Huh?” His job is to hold down the government’s health care costs, particularly Medicare and Medicaid, not all health care costs. Having seen its budget surplus fold faster than the Taliban, the federal government is now going to get some of its dollars back by cutting Medicare payments to doctors this year by an average of 13 percent. Rush ‘n’ Muck.

Take doctors. Most don’t see it as their jobs to control health care costs. They take care of patients and they take care of themselves, and if they can be cost-effective, that is good but not required. Hammered in recent years by cuts in payments from the government and insurers, doctors are turning to hospitals to be paid for being on call and other work, and working together to collectively bargain for higher reimbursements from health insurance companies. Many will stop seeing Medicare and Medicaid patients as dwindling payments for services mean losing money when one walks in the door. Rush ‘n’ Muck.

Take hospitals. It is not really their job to cut our health care costs, either. They also take care of patients and take care of themselves. They need to control their health care costs enough to have a positive bottom line so they can stay in business. If the only way to survive is by increasing hospital rates to health insurance companies because Medicare and Medicaid payments to hospitals amount to 50 cents on the dollar, so be it. Rush ‘n’ Muck.

Patients are really no different. The truth is that the only health care costs most of us want to control are our own. Our concerns about costly X-rays, for example, are more about what share of them we will have to pay for than whether the test is truly necessary. About 80 percent of us have some of our health care costs paid by some form of insurance, and the better insured we are the more insulated we are from the health care costs we individually generate. Rush ‘n’ Muck.

Pharmaceutical companies are in the business of generating profits for themselves and stockholders, not cutting our costs. They have everything to lose in any system that effectively controls health care costs because they are the most profitable segment of the health care industry. Every $3 pill is pharmaceutical Rush ‘n’ Muck.

Finally, health insurance companies and employers are also in the game only to control their own costs and survive. They will protect their own bottom lines, if necessary by taking dollars away from doctors, hospitals, pharmaceutical companies, etc., and by shifting costs back to patients. More Rush ‘n’ Muck.

The amazing and sad truth is that total health care cost control is the most important job in America right now with no one really doing it, which is why it is not getting done. And that piece of fresh meat that just picked up the ball? That is the patient, who had better run like greased lightning.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.