No government rate-setting is correct. Physicians do have one advantage - health insurance supplements which pay all or some of the delta between the billed rate and the government-set rate. In attorney situations where the government is the defendant, the court can retroactively set the hourly rate (no supplementing allowed) and disallow numbers of hours and expenses. For a case that can take 2-5 years to resolve and all of the expenses borne by the attorney during that time frame, it doesn't take more than a couple of these to discontinue servicing that clientele.