Physician-Run Health Plans and Antitrust

TO THE EDITOR:

I have several concerns about the American College of Physicians' policy statement on antitrust matters [1].

The policy position begins with the assertion that the health care industry has been treated the same as every other industry, even though physicians are restricted to 20% or 30% of market share, depending on whether or not contracts are exclusive, exceptions notwithstanding. The presentation, in attempting to balance its discussion of pros and cons, fails to convey just how sharp and great are the differences between these two camps. For example, the American Medical Association has antitrust reform as one of its highest priorities, and the members of the House of Delegates are extremely passionate and strong in their feelings on this matter. In muting the intensity of these feelings, the College strikes a position that is deeply divisive in the house of medicine at a time when unity is of fundamental importance. Little attention is given to how the antitrust chill has almost frozen out peer review in medical communities so that the only such venue is within the managed care organization or a formal physician-run organization mechanism. The College seems to rely on the good will and flexibility of the bureaucracy in modifying its rules and regulations at its own whim or after studying the impact on physicians affected by a rapidly developing marketplace. Such a plan would mean that the antitrust wounds of physicians, finally discovered by such a monitoring process, would be several years old and healed by secondary intention.