Rising health care costs are a classic example of the tragedy of the commons[1]. In general, human needs are boundless, and as long as the people who make deci

Rising health care costs are a classic example of the tragedy of the commons[1]. In general, human needs are boundless, and as long as the people who make decisions about healthcare use do not bear the associated costs, health care costs will keep increasing. The costs are two-fold : the financial cost of the medication, the doctor’s visits or the procedure and the moral or existential cost to the person who receives the care. I argue that even in a fully subsidized, “free” healthcare system costs would not rise as fast as they are now in the USA (and elsewhere in the developed world) as long as healthcare use was only decided by the patient, who is the only one to suffer during futile procedures. It is not surprising that care is most expensive in the ICU and the long-term facilities for the demented or otherwise disabled — in those setting the patients themselves do not decide, and their families bear nor the actual costs nor the sufferings incurred. Anecdotally, those family members who care the least in everyday life, who never come to see the patient, are those who push the most for expensive, pointless care, who demand that “everything be done”. Every day, demented patients are shipped, alone and frightened, to emergency rooms, where they are put into restraints and treated for their tenth episode of aspiration pneumonia while their next of kin stay home watching TV and never bother to come. [1] https://en.wikipedia.org/wiki/Tragedy_of_the_commons https://en.wikipedia.org/wiki/Tragedy_of_the_commons