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July 1, 2000, Saturday, Late Edition - Final

SECTION: Section A; Page 9; Column 3; National Desk

LENGTH: 1026 words

HEADLINE: Doctor's Antitrust Hopes Face a Roadblock From Lott

BYLINE: By ROBERT PEAR

DATELINE: WASHINGTON, June 30

BODY:
Elated with a big victory in the House, doctors opened a campaign today 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 the Senate majority leader, Trent Lott, Republican of Mississippi, said he would stand in their way. The House passed a bill to exempt doctors from major provisions of the antitrust laws early today. The final vote, at 2 a.m., was 276 to 136, with a two-thirds majority heeding the doctors' pleas for relief.

The chief sponsor of the bill, Representative Tom Campbell, Republican of California, and his allies at the American Medical Association said the lopsided vote in the House would give them momentum in the Senate.

But Mr. Lott expressed opposition, saying: "I don't think we need more lawsuits in America. And I don't think we need more, you know, labor unions in America. And that's basically what they're trying to do. So I certainly don't look on it favorably. And I won't be trying to find a way to pass it, I'll tell you that."

Mr. Lott's position reduces the chances that the bill will get through the Senate this year. No senator has introduced such legislation, though Mr. Campbell and the A.M.A. 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 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, Tex., 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," Mr. Campbell said. "Medical professionals should be allowed to provide care for their patients as they think best, and today Congress empowered them to do so."

House passage of the Campbell bill has set off a titanic battle of lobbyists that mirrors the struggle between doctors and insurance companies to control patient care.

The A.M.A. has a formidable team of lobbyists. Dr. Donald J. Palmisano, a trustee of the association, said he sent e-mail messages to hundreds of doctors in the course of the House debate, and they flooded Congressional offices with phone calls urging passage of the Campbell bill.

In an e-mail message sent to doctors at 3:15 a.m. today, Dr. Palmisano said: "Wow! We had an impressive win. Now on to the Senate and the president. We must continue to push hard and not accept the naysayers' view. They have been 100 percent wrong so far."

Insurance companies, H.M.O.'s and business groups like the United States Chamber of Commerce have waged an even bigger campaign against the bill. They said they would press their arguments next week in meetings with senators home for the Fourth of July recess.

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

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 Federal Trade Commission and the Justice Department have filed numerous cases alleging that doctors boycotted H.M.O.'s, tried to fix prices or conspired to thwart the cost-control efforts of managed care organizations. Robert Pitofsky, chairman of the commission, said the Campbell bill would legalize such conduct.

The Consumer Federation of America opposed the bill. But dozens of liberal Democrats, who take pride in being consumer advocates, voted for it, saying the bill would correct the imbalance of power between doctors and insurance companies.

Representative David E. Bonior of Michigan, the Democratic whip, a staunch ally of organized labor, said the bill "reinforces the value of collective bargaining in our society."

Doctors said they needed the Campbell bill so they could serve more effectively as advocates for their patients in negotiations with insurance companies.

But Travis B. Plunkett, legislative director of the Consumer Federation of America, said, "When doctors express such concerns, it's often merely an attempt to improve their economic position in the guise of quality of care."

The Campbell bill does not give doctors any new right to strike, or to withhold services from patients. But Mr. 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.

Mr. Campbell is running for the Senate against Senator Dianne Feinstein, a Democrat. She has not taken a position on the bill, but has suggested that patients would be better served if Congress simply passed the patients' bill of rights.
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GRAPHIC: Photo: Senator Trent Lott, the majority leader, said yesterday that he would fight doctors' efforts to win approval for an exemption from antitrust laws. Mr. Lott, right, left a news conference with his chief of staff, David Hoppe. (Carol T. Powers for The New York Times)

LOAD-DATE: July 1, 2000