The Sept. 28 front-page story "Higher Costs, Less Care" quotes a report by the advocacy group Families USA as saying: "Hospitals and physicians recover these dollars by raising fees and charges, which in turn increases total private insurance costs."

While health insurance premiums have soared in the past five years, the rising costs of practicing medicine are not being passed on to patients by doctors and hospitals. As a pulmonologist, I can tell you that doctors can raise their rates, but that does not mean they will be paid more. Insurance companies will pay what they deem is appropriate, regardless, and doctors and hospitals do not have much say about it.

As the insurance companies bring in more money to boost their profits, their shareholders and their managers' salary and benefits, most physician and hospital reimbursements have remained fairly flat.

So how do doctors and hospitals survive when costs keep rising and their revenue is stagnant? Save the tired argument of increased efficiency. I already drive to three hospitals. Perhaps people instead should question the multimillion-dollar salaries and stock options paid to management at insurance companies, and I do not mean just the chief executives.

Meanwhile, my malpractice premiums have increased 40 percent this year alone.