AMA asks for shift in health care antitrust enforcement

American Medical Association President-elect Donald J. Palmisano, MD, JD, called on the Federal Trade Commission to redirect its efforts in health care antitrust enforcement to begin focusing on HMOs and health plans, not just physicians, according to a Sept. 9 AMA news release.

"To our knowledge, the commission has never brought a single enforcement action against a health insurance company, HMO, health plan or other third-party payer," Palmisano said. "The absence of enforcement activity on the payer side is puzzling, because there are plenty of reasons to be concerned about the competitiveness of payer markets.

"In the latter half of the 1990s, managed care organizations consolidated at a record pace. Today, we are seeing double-digit increases in health premiums and in health-plan profits.

"At the same time, patients have expressed deep dissatisfaction with managed care, and physicians have found themselves vastly overpowered in their dealings with payers.

"In any other industry, a merger wave followed by an abrupt rise in prices would cry out for an investigation. But so far, unless we are mistaken, these conditions have simply led to renewed calls by the commission to get tough' against physicians and other health care providers. Something is amiss. Our suggestion today is that the time is ripe for the commission to consider a fundamental shift in how it deploys its resources in the health care field."

Palmisano cited a recent AMA study of the health care marketplace that found that in a significant number of markets, health insurers have substantial leverage over patients and physicians in determining the scope, coverage and quality of medical care.

Catherine Hanson, JD, general counsel for the California Medical Association, also testified on behalf of the AMA, asking the FTC to take a fresh look at the core principles guiding antitrust enforcement with respect to physicians.