What is our social responsibility? Garrett Hardin, professor of biology, University of California, Santa Barbara tells us about herders who, not out of greed, but out of practical necessity graze more cattle than the finite, common land can support, ruining it for everyone.

This exploitation is analogous to what happens when incentives are not aligned in a health care system (or 'non-system,' as it were) with payers, practitioners and patients doing what they feel they must without accountability for cost-effectiveness or cost-utility.

Hardin G. "“The Tragedy of the Commons”." Science 1968;162:1243-1248. [Free Full Text]

Although Professor Hardin was speaking to issues of our fragile planet, his message is apropos of the current healthcare reform discussion: the business of medicine is medical business.  It is not insurance business; not specialist before primary care; not mindless and not cookbook medicine.