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July 1, 2000 Saturday FINAL EDITION

SECTION: NEWS; Pg. 03A

LENGTH: 613 words

HEADLINE: Doctors turn to Senate for antitrust exemption;
House victory advances plan aimed at bargaining with insurance companies

BYLINE: ROBERT PEAR New York Times

BODY:
Washington -- Elated by a big victory in the House, doctors opened a campaign Friday to persuade the Senate to give them an exemption from antitrust laws so they could bargain collectively with insurance companies over fees and other issues.

But Senate Majority Leader Trent Lott (R-Miss.) said he would stand in their way.

The House passed a bill to exempt doctors from major provisions of the antitrust laws early Friday. The final vote, at 2 a.m., was 276-136, with a two-thirds majority heeding the doctors' pleas for relief. Wisconsin's lawmakers voted in favor, except Republican F. James Sensenbrenner Jr. of Menomonee Falls and Democrats Tammy Baldwin of Madison and Tom Barrett of Milwaukee, who voted against. The chief sponsor of the bill, Rep. Tom Campbell (R-Calif.) and his allies at the American Medical Association said the lopsided vote in the House would give them momentum in the Senate.

Lott's position reduces the chances that the bill will get through the Senate this year. No senator has introduced such legislation, though Campbell and the AMA are trying to find a senator, preferably a Republican, to take up the cause.

Senate Republican leaders are in no hurry to help the association. Indeed, the Republican leaders are upset with the group because doctors have worked closely with President Clinton and with Democrats in Congress to pass a Democratic bill defining patients' rights in a much more expansive way than Republicans want.

The Campbell bill would exempt health care professionals from provisions of the antitrust laws when they negotiate with health maintenance organizations and insurers over fees and contract terms.

In the last 20 years, doctors have often been accused of violating the seminal antitrust law, the Sherman Act of 1890, which prohibits contracts, combinations and conspiracies in restraint of trade. The law applies to doctors as it applies to vitamin manufacturers and road construction companies.

In a typical case, the Federal Trade Commission asserted that patients and employers had been forced to bear more than $1 million in increased costs because of a price-fixing conspiracy by surgeons in Austin, Texas, in 1998 and 1999.

Doctors who are employees -- at hospitals, for example -- can join labor unions and collectively negotiate with their employers under existing law. The House bill would grant similar immunity from the antitrust laws to independent doctors.

Doctors said they needed more leverage to negotiate on working conditions, the quality of care, the number of patients they must see in a day and similar issues.

"This bill helps doctors help their patients -- nothing more, nothing less," Campbell said Friday. "Medical professionals should be allowed to provide care for their patients as they think best, and today Congress empowered them to do so. "

The bill is opposed by groups representing nurses, nurse practitioners and midwives, who fear that doctors will demand that health plans restrict the role of such non-physicians.

Antitrust officials at the Federal Trade Commission and the Justice Department also opposed the Campbell bill, saying it would enable doctors to raise their fees. As a result, the officials said, employers and individual purchasers of health insurance would have to pay higher premiums, and spending for Medicare and Medicaid would increase.

The Campbell bill does not give doctors any new right to strike, or to withhold services from patients. But FTC Chairman Robert Pitofsky said it would give doctors "coercive power" because they could back their demands for higher fees by collectively refusing to deal with certain health plans.

LOAD-DATE: July 1, 2000