The United States and New Zealand are the only high-income countries that permit direct-to-consumer advertising of prescription drugs. American pharmaceutical companies spent $6.58 billion on it in 2020, up more than tenfold from 1996.
The standard closing line of every one of those advertisements is an instruction to the patient: ask your doctor about it. The system is built on the assumption that the patient will raise the subject, not that the physician will.
Twelve ordinary citizens, selected at random, with no training in law, decide questions of fact — and in the United States they do so in civil cases as well as criminal ones, far more often than in any comparable system. The verdict is not reviewable on the facts. The credentialed authority in the room instructs on the law and then waits.
Truman kept a sign on his desk in the Oval Office reading exactly that, and used the phrase repeatedly to describe the presidency. The buck is passed, in American usage, from one person to another. The sign announces where the passing ends — at a named individual, in a specific room.
Directly Responsible Individual. Apple’s internal practice attaches a single name to every item on a meeting agenda, and the name is visible to everyone. American project management more broadly insists on one accountable person per item, and the phrase single throat to choke is used without embarrassment.
Product owner. Process owner. Account owner. Risk owner. Problem owner. American organizations name roles after possession of the thing rather than responsibility for a function, and the word carries the expectation that the owner acts without being asked.
Americans represent themselves in court in substantial numbers, and the courts accommodate it. Small claims courts are designed for it, often barring lawyers outright. The premise is that an ordinary person can conduct their own case against another party, and that the system should make that possible rather than discourage it.
In roughly half the states, citizens who gather enough signatures can put a law directly on the ballot, bypassing the legislature entirely. California has used this to write tax law, criminal sentencing and labour regulation. The power to legislate does not stop with the people elected to legislate.
American patients are actively encouraged to seek one, by insurers, by patient advocacy groups, and often by physicians themselves. Doing so is not treated as a discourtesy to the first doctor. The patient is understood to be the one deciding.
Home Depot and Lowe’s are among the largest retailers in the United States, and both are built on the premise that homeowners will do the work themselves — electrical, plumbing, structural. American building codes generally permit a homeowner to do work on their own dwelling that would require a licensed trade elsewhere.
The phrase functions in American workplaces as a serious accusation rather than a statement of scope. Saying it about someone marks them as having seen a problem and stepped around it — which, in a culture where the person nearest the problem is expected to take it, is a charge of failure rather than a description of their role.