The authors of this article argue that technology and change in regulations will effectively address concerns about a looming doctor shortage. Underscoring their assumptions is the novel concept that medicine ought not be immune from innovation at the system and delivery level, in much the same way that other businesses have changed and adapted.

As interesting as the article is, the comments by readers are even more so, both in their content and in the defensive fears that underscore many, accompanied by a cry to preserve the basic status quo while raising reimbursement. The devil of Medicaid is raised by more than one, claiming that treating such patients is simply unaffordable, thus diverting doctors to lucrative concierge practices.

So called mid-level practitioners including PAs (physicians assistants) and nurse practitioners are alternately praised or criticized, based more upon feelings and anecdotes than data.

The basic theme of the naysayers is leave the system alone, increase reimbursement, continue with fee-for-service excesses and basically make an unviable system even worse as a result. The clear lack of consensus based largely upon one’s personal interests or politics underscores virtually every aspect of the health care debate.

Health care in the US is belatedly being thrust into the real world of economics, where those paying get say in what they are willing to buy and willing to spend. This concept is simple in most things, where we open our own wallets. But when it comes to the wallet of employers, fellow citizens and government – those who pay for our healthcare, we have a medical equivalent of  “the tragedy of the commons,” an economics theory by Garrett Hardin, according to which “the depletion of a shared resource by individuals, acting independently and rationally according to each one’s self-interest, despite their understanding that depleting the common resource is contrary to the group’s long-term best interests.”

In this case, we individuals are depleting the shared resource of the health care system by acting in our own self-interests to the detriment of all.