I was intrigued by the letter from Jill Johnson (“A bad case of doctor distribution,” Voice, Sept. 29), which said that, in Florida, one must wait to see a physician. She also noted that it is difficult to find a pediatric cancer specialist in rural areas.
She attributes these observations to her perceptions that physicians “get away with setting their own prices, not meeting the market’s needs and still receiving support from the federal government to continue the practice.”
What decade of history is she recalling? Medicare/Medicaid fees are strictly controlled. Doctors cannot bill patients directly or charge anything above what the government arbitrarily allows. Reimbursements are being cut, often drastically. Private insurers are increasingly basing reimbursements on the Medicare fee schedule, often undercutting it. Anyone can set his or her own prices, but if nobody (patient, insurance, Medicare) pays it, is it really “set”?
Some say that it is about time that doctor fees are decreased. The problem: As third-party payers tighten controls, doctors can be forced to pay attention to the whims of the payers. Reimbursements are particularly low in Florida, where price competition among doctors has been especially keen. Such “market forces” may be responsible for Ms. Johnson’s difficulty in getting the care she desires, rather than her perception that physicians set up practice wherever they want and can charge as much as they wish.
