On September 15, I read a headline in the Wall Street Journal indicating that physicians in the American College of Physicians—all 79 000 of us—agreed to cap our fees. I wondered, when I was offered a chance to vote in a referendum on this public policy statement? I called the ACP and was told that the press had not correctly represented the balanced tone of the published statement. What naivete! That day, all electronic news media and The Plain Dealer blared forth with this message: 79 000 physicians want their fees regulated by the government. Not until September 18 did my issue arrive. I read the proposal twice [1] before detecting the headline message of the media, but there it was. Did this well-meaning group of policy writers understand that the public would only get one message from this position paper?

The idealism of the committee's paper does not repeal the rule that one gets what one pays for, including good medical care. Some doctors are better than others, contrary to assumptions underlying the paper, and should be paid more by willing patients than the high-volume, lowest-cost "producer." The conscientious, thorough internist will continue to be wiped clean by such schemes of payment [2].

This paper assumes that physicians are and should only be motivated by idealism. Our society favors individuals with initiative: intellectual, spiritual, humanitarian, scientific, and clinical. "Doing right" and "taking risks" are behaviors that are taught and rewarded in our culture. Moreover, what about inflation? Every such scheme makes participants susceptible to its ravages.

Finally, I am offended by anybody speaking for me when my opinion or recommendation has not been sought. I think it is blatantly patronizing for the ACP to speak for its membership without consulting it widely and directly.