Antitrust bill: Still waiting for a fair deal

Rep. Tom Campbell's much-delayed "Quality Health Care Coalition Act" now faces possible hearings before as many as three additional House committees -- to the delight of the managed care industry, which fears and despises the Campbell bill as much as it does patient rights legislation.

Editorial. April 24, 2000.

Patience has been a necessity for those following the progress of Rep. Tom Campbell's "Quality Health Care Coalition Act," the measure that would give independent physicians the chance to join together and negotiate collectively with health plans.

The bill was stalled by the House leadership just days before a much anticipated committee vote in October 1999. It was expected to come up again in February but didn't. There were several postponements last month before the bill was approved by the Judiciary Committee March 30. At least the margin was a very satisfying, and bipartisan, 26-2. This was an outcome that the AMA and organized medicine had worked hard for.

It would be reasonable to assume the measure is finally headed to a vote of the full House, where it has more than 200 co-sponsors. But that may not be the case. Three other committee chairs have announced that they would like to hold their own hearings, claiming concerns that the Campbell bill might raise health care costs. At press time it was unclear if those attempts would succeed. The matter was in the hands of House Speaker J. Dennis Hastert (R, Ill.).

These delays are much to the delight of the managed care industry, which fears and despises the Campbell bill as much as it does patient rights legislation. As is also the case with patient rights, that industry is doing its own hard-core lobbying, including spinning unrealistic doomsday scenarios about the impact of the bill.

In the Capitol, where to delay is to destroy, there is nothing that health plans would like more than additional hearings designed to puzzle out the impact of an already closely studied bill. (An analysis commissioned by the AMA found that the economic effect of the Campbell bill would likely be negligible in terms of the overall health care economy, and even that cost may well be outweighed by benefits to the system.)

An amendment added to the bill by Justice Committee Chair Rep. Henry Hyde (R, Ill.), would safely establish the truth about any Campbell effect in a setting that no one should quibble over -- the real world. The Hyde amendment would sunset the law after three years and not allow it to be extended until the General Accounting Office completed a survey of its impact. At the price of a little bit of patience, everyone would know the real story.

While Campbell watchers wait for the House vote, the status quo remains that independent doctors are left with no effective way to negotiate with health plans and to protect themselves and their patients. Where doctors are concerned, powerful health plans often show little patience, from their take-it-or-leave-it contracts, to changing contract provisions on a whim, to dropping fees or even dropping the doctors -- all whenever it suits the plan. All the while, the consolidation that drives such power goes on, with relatively little fear by plans of government antitrust intervention.

As is often reported, about a half-dozen major for-profit plans now hold much of the leverage in the overall managed care market, in addition to well-entrenched Blues plans. But the national figures, while striking in themselves, only suggest at what is going on in local markets. To the independent physician -- and ultimately to the patient -- the most important market conditions are those right outside the practice door. It is those figures that put the need for the Campbell bill into very sharp focus.

A good rule of thumb is when a single plan has a third of the managed care market in a community, it is getting too big for most practices to ignore. Such dominance is the case in more than 80% of the roughly 320 top metropolitan markets in the country. Even by a stricter standard of 50% market share -- at the point a medical practice has virtually no choice but to sign up if the doctor wants to stay in business -- nearly half the top metro markets in the country meet that criteria.

Physicians need and want (albeit through gritted teeth) that health plan business. All they are asking for with the Campbell bill -- and all they realistically can expect -- is the chance to try to strike a fair deal.

The alternative is for physicians to sit tight and hope that health plans on their own will change their ways.

But, really, could anyone be expected to wait that long?