A national effort to promote collective bargaining for physicians suffered a stinging blow last month when the District of Columbia's financial control board voided a bill that would have provided a special antitrust exemption to doctors.
The action comes more than half a year after the city council voted 10-2 to allow the estimated 10,600 D.C.-based physicians to negotiate patient fees. Supported by the American Medical Association, it was only the third law of its kind in the U.S. and a model for many others under consideration by state legislatures across the U.S.
The decision was criticized harshly by Donald Palmisano, M.D., a member of the AMA's board of trustees and the organization's point man for the nationwide collective-bargaining movement.
"The D.C. control board's curious decision to block independent physicians' bargaining power with healthcare companies leaves Washington patients at the mercy of big HMOs and defenseless against the abuses of managed care. The D.C. control board's action puts insurers right where they have lobbied to be-in the driver's seat-and leaves patients out in the cold. Once again, it's dollars first and patients second."
The district's collective-bargaining law was passed about a year after the Texas Legislature approved a similar measure. A similar law has been in effect in Washington state for more than 16 years.
The control board, voting for the first time to reverse a law passed by the council, rejected the measure after the district's chief financial officer estimated that it would have cost from $190,000 to $875,000 more than budgeted for healthcare in the current fiscal year. Estimates also suggested it would have cost the district as much as $3.2 million per year by 2004.
Councilman Phil Mendelson, one of the sponsors of the bill, said the board based its vote on incorrect figures, arguing that indirect costs to health insurers should not have been considered.
The Health Insurers Association of America, which opposed the bill, described the board's action as a "victory for consumers."
"This bill would have exempted doctors and other healthcare professionals from antitrust laws," said Charles "Chip" Kahn, president of the insurance association. "In so doing, the bill could have raised health insurance premiums for district-area residents by more than 13% a year."
He said an HIAA-commissioned study determined that the bill could have increased district-area health spending by as much as $1.1 billion per year. He said it also would have been an impediment for the estimated 80,000 district residents now uninsured, most of whom can't afford the costs of coverage.
An AMA spokesman said his organization will continue to push for federal legislation to exempt physicians from antitrust restrictions, making actions like the control board's a "moot point." But he said that little could be done to change the board's decision.