The "Quality Health Care Coalition Act": Can Antitrust Law Improve Patient Care?
Berman, Micah, Stanford Law Review
In March 1999, Rep. Tom Campbell (R-CA) introduced H.R. 1304, the "Quality Health-Care Coalition Act."(1) At a press conference announcing the bill's introduction, Rep. Campbell--joined by a Democratic co-sponsor, Rep. John Conyers (D-MI)--explained that H.R. 1304 would attempt to "level the playing field between HMOs and health care providers and return medical [decisionmaking] from insurance administrators to individual physicians ... and their patients."(2) This legislation, he declared, is "the best way to let the market deal with the complaints so many health care professionals have raised with HMOs."(3)
The premise of H.R. 1304 is simple: Doctors should be allowed to engage in collective bargaining with health plans.(4) As discussed below, such collective action is generally barred at present by antitrust laws. By overriding these antitrust laws and providing health care providers with collective bargaining rights, the bill would, according to its sponsors, "level the playing field" between providers and HMOs.(5) As the American Medical Association (AMA)--a powerful proponent of the Campbell Bill--argues, collective bargaining powers would provide "a counterbalance to the growing power of insurers" who would otherwise "choose profits over patients."(6)
The premise of H.R. 1304 is not only simple; it is politically popular as well. After its introduction, the Campbell Bill quickly attracted support from across the political spectrum,(7) building a bipartisan list of co-sponsors that eventually included more than half the members of the House of Representatives.(8) Although it took more than fifteen months to bring the bill to the House floor, H.R. 1304 passed the House by an overwhelming 276-136 margin on June 30, 2000, when it finally came up for a vote.(9) Due to opposition from Senate Majority Leader Trent Lott and other Senate Republican leaders, the Campbell Bill remained bottled up in a Senate committee for the remainder of the 106th Congress.(10) However, the bill will certainly be reintroduced in the Senate during the upcoming term.(11) In short, H.R. 1304 stands a substantial chance of becoming law within the next couple of years.
Notwithstanding its chances of passage, the Campbell Bill also touches on some of the most fundamental questions currently facing the health care industry: Does the distribution of power between HMOs and physicians need to be "balanced"? If so, what is the best way to achieve the proper equilibrium? Who should be responsible for making final decisions about patient care? The Campbell Bill offers one set of answers to these questions, but other legislators and commentators offer competing recommendations and solutions. Whether or not H.R. 1304 becomes law, the debate over these questions will be central to American political dialogue for years to come. The decisions ultimately made in the political realm--through votes on H.R. 1304 and other related measures--will play a major role in defining the character of the U.S. health care system.
For these reasons--because H.R. 1304 stands a substantial chance of becoming law and because the questions it raises are fundamental to the future of American health care--it is important to analyze both the need for such legislation and the impact that H.R. 1304 would have upon the health care industry if enacted. In attempting to address these issues, this note will proceed in four Parts. First, Part I will set the scene by discussing the major criticisms that doctors have leveled at HMOs. Rep. Campbell has made doctor complaints about HMOs a major justification for his legislation. Part II will then explain the existing legal framework within which the debate takes place. H.R. 1304 straddles two significant legal disciplines, antitrust law and labor law, and this Part will review the application of these legal regimes to doctors and HMOs. Next, Part III will present the Campbell Bill itself and outline its major features. …