For consumer groups, playing politics in the physician antitrust debate is a lot like betting on a favorite horse at the track.
In this case, the sure thing is that a bill that would grant an antitrust exemption to physicians will go nowhere this year. And if the bill is going nowhere, odds are that consumer groups don't need to oppose it and jeopardize their relationship with the American Medical Association in the process.
Just about every healthcare lobbying outfit but physician organizations is lining up to oppose the House bill, which would allow doctors to collectively bargain with health plans.
Hospitals, nurses, insurers and employers have united under the banner of the Antitrust Coalition for Consumer Choice in Health Care. Their argument: Allowing independent physicians to come together and negotiate payment rates and other contract terms will jack up healthcare costs.
Their fears appear to have some foundation, according to a cost estimate released by the Congressional Budget Office two weeks ago. The CBO estimates that the bill, if passed, will result in higher insurance premiums and increased utilization of services (March 20, p. 6).
That begs the question: Where are the consumer groups?
Most consumer organizations haven't taken a public stand on the bill, which is co-sponsored by Reps. Tom Campbell (R-Calif.) and John Conyers Jr. (D-Mich.).
They say that with a legislative agenda including such meaty issues as managed-care reform and Medicare prescription drug benefits, they don't have the resources to tackle everything.
"There's so much cooking," says Gail Shearer, director of health policy analysis for the Washington office of Consumers Union, in a typical response. "There's a limit to what we can get into and do an in-depth job on."
However, one consumer group, the Consumer Federation of America, has vocally opposed the bill. Travis Plunkett, the federation's legislative director, says the proposal would take healthcare consumers "from the frying pan into the fire."
"We oppose it strongly," Plunkett says. "We agree with many doctors' concerns, but we strongly disagree that this is the way to fix that."
Several healthcare lobbyists say off the record that most national consumer groups simply don't want to publicly oppose the AMA, which supports the Campbell bill.
Politically speaking, those groups traditionally don't align with big insurance companies, which they would be doing if they opposed the Campbell bill. At the same time, consumers have teamed up with the AMA and organized labor to push for managed-care reform, which the insurers oppose (See chart).
The Campbell bill will not become law unless the Senate passes a similar measure, and to date no senator has introduced such a proposal. By avoiding the House bill and hoping it dies quietly, consumer groups are able to maintain their good relationship with the AMA.
However, if a similar bill is proposed in the Senate, consumers could be in the awkward position of fighting with the insurers on one front and against them on another, the lobbyists say.
Many doubt that such a bill will be introduced in the Senate.
"There will be no Senate bill because it's not a good idea," says one healthcare lobbyist. "The Senate tends to think about these things more, where the House kind of goes with the whim of the people."
The Campbell bill boasts 208 co-sponsors, and its popularity is perplexing considering that no Senate companion exists.
Some healthcare lobbyists speculate that Republicans are signing on to the Campbell bill in droves because it's an election year. Republicans, who angered doctors by trying to thwart managed-care reform, now find that they need campaign contributions.
"(House members) feel that they can vote for the Campbell bill and make the doctors happy, and they don't have to worry about it going anywhere," one lobbyist says. "The House is relying on the Senate not to do anything."
House members also don't have to worry about increasing the government's healthcare costs. The Judiciary Committee passed an amendment to the bill that removed Medicare and Medicaid from the scope of the bill, making private payers the only ones subject to collective bargaining.