Health care in rural areas remains spotty. Some areas have thriving medical communities, while others are virtually doctorless. There are many barriers to rural practice, but Medicare shoud not be one. Rural doctors plead for equal pay: Lawmakers from underserved areas also push for an easing of the geographic disparity in Medicare physician payment.

Thousands of family physicians in rural areas are facing similar crises, and many believe Medicare payment policy is to blame. A 5.4% cut in Medicare rates in 2002 has only exacerbated previous funding shortfalls that are driving primary care doctors from rural areas.

"If our reimbursement rates continue to go down and our expenses continue to go up, you will see an exodus of physicians out of rural areas like Moses out of Egypt," Dr. Casey said. "The practice of medicine is like any other business. If you can't pay your bills, you can't survive."

As long as the government controls reimbursement and sets requirements which increase overhead, we will have this problem. We have bureaucracy run amok. Reading about the Canadian and British health systems only supports my distrust of bureaucracy - they are in worse shape than we are. Bureaucrats and insurers do not care about patient care - they care about statistics and finances. That is the problem.

Legislatures need to remember that each problem fix has unintended consequences. These unintended consequences usually cost money. Each sanctimonious congressman and senator needs to understand the implications of their rules on health care costs. Where did common sense go?