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Published at www.nejm.org August 26, 2009 (10.1056/NEJMopv0907258)

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Garrett Hardin's essay "The Tragedy of the Commons"¹ aptly describes the current state of the U.S. health care system. Hardin tells the story of herders who make what are individually rational decisions to exploit common land by grazing as many cattle as possible, to the ultimate detriment of the land and consequently the common good. The herders are not villains; rather, they are doing what makes sense given the system in place. Analogously, many observers are currently tempted to cast certain players in the health care arena as villains, but they are merely doing what is rational given the current . . . [Full Text of this Article]

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Washington Hospital Center
Washington, D.C.

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