To the editor:

Your editorial, "Are Doctors Charging Too Much?" reveals an acute lack of understanding about how the Medicare program works, a lack of initiative on the part of the author, and a conclusion which could not be supported if the facts were known.Much of the confusion generated by the editorial is derived from the author's misinterpretation of the term "reasonable," in connection with the fees doctors are allowed to charge Medicare patients.

The term "reasonable" is simply a congressionally mandated label for "allotted" or "allowed." Very few would agree that the government's reimbursement for physician services is literally "reasonable."

In the Medicare program, what the government deems is a "reasonable" charge is not comparable to what the average physicians charges or what physicians or insurance companies agree is "reasonable."

Few people realize that although all Medicare patients pay the same taxes and premiums nationwide, each state is reimbursed differently. Medicare "reasonable" fees heavily favor the more populous states, and reimbursement across the country may vary as much as 300 percent for the same procedure.

A recent study of selected, commonly performed procedures showed that only five of the 50 states are reimbursed for these procedures at lower rates than Utah.

The variations in reimbursement are not just confined to urban versus rural states. For example, physicians in southern Nevada are paid almost twice what Utah doctors receive from Medicare for providing the same services, but the Utah physician's cost of providing care is about at the national average.

Your editorial also stated that the government adjusts the usual Medicare charge on physicians' services each year for inflation. That statement is just not so. Medicare's economic index is based upon 1971 data and, at least in Utah, has come nowhere near to matching the increases in the cost of providing health care since then.

This fact was explained to the author of your editorial prior to its publication, yet she responded in print as follows: "Is that because the index is inadequate or because physicians are raking in too much profit?" That would be a fair question if she had taken the time to answer it. Instead she just let it hang there, taking advantage of the innuendo.

Instead of badgering doctors for not charging the severely limited Medicare fees for Utah, a more appropriate target for your editorial might be the federal government, which has constantly sacrificed quality medical care to create the illusion that it is providing the same health care to everyone.

If the Medicare program reimbursed Utah physicians "reasonably" for the services they provide, then the physicians could charge the same price to all patients.

Craig L. Booth, M.D.


Utah Medical Association