There are many major issues involved in the escalating costs of health care. One that is glaringly absent is higher physician reimbursement ["On ending the waste in health care," Notable on, Sept. 18].

Most factors driving up the costs of health care involve an aging population, costs involved with caring for the terminally ill, a population and society that demand high-tech and high-cost medical care, increasing malpractice premiums, and the legal climate that all physicians face every day.

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Health insurance premiums have also shot through the roof over the last few years due to the elimination of the $1-million lifetime cap on major medical and the extension of insurance to children still living with their parents beyond college years. In addition, many high-level health insurance executives are reaping huge salaries and exorbitant stock growth and dividends for their shareholders.

Physicians, for the most part, have not gotten any raises in reimbursement, to speak of, from most insurance plans in many years. Most are working longer hours and seeing more patients, yet net incomes are dwindling due to higher costs of running our practices.

Perhaps it's time to outlaw for-profit health insurance companies and limit the compensation many chief executives are commanding. Also, some of the burden should be placed on those in our society who use or will use the health care system more, such as those who smoke, drink and use illegal drugs.

Dr. Paul Kesselman, Woodside

Editor's note: The writer is a podiatrist in private practice.