FPD Private News & Updates3

MICHAEL PIERCE CONNAIR, M.D.
12 VILLAGE STREET
NORTH HAVEN, CT 06473
OFFICE: 203-777-2044 CELL PHONE: 203-982-3626 FAX: 203-773-3641

October 21, 2009 Fax: 202-225-0072

Dear Chairman Conyers:

On behalf of the Federation of Physicians and Dentists and the National Union of Hospital and Healthcare Employees (AFSCME, AFL-CIO), I offer enthusiastic support for the Health Insurance Industry Antitrust Enforcement Act of 2009 (H.R. 3596). This legislation is a vital component of any effort to reform the American health care system.

Failure to enforce antitrust principles against health care insurers, combined with the perverse vigorous enforcement of the Healthcare Antitrust Enforcement Guidelines against physicians and physician organizations has caused or contributed to:

·	Physician shortages in many geographic markets (examples include no neurosurgical coverage some nights for the eastern half of Connecticut, and dwindling numbers of reconstructive plastic surgeons since cosmetic surgery is far more lucrative);

Inability to recruit medical students and residents into primary care and some medical specialties like pediatric orthopaedics (look at how difficult it has been to provide primary care services to newly insured Massachusetts residents after its universal insurance mandate; more pediatric orthopedists retire each year than are trained);

·	Use of the Department of Justice (DOJ) and Federal Trade Commission (FTC) to prosecute physicians for alleged antitrust violations rather than harnessing those agencies to assist in mediating contracts that balance the interests of all parties;

·	Economic rationing of patient care/physician services to maximize insurance company profit rather than to insure the health of the patient;

·	Physicians pursuing profit centers other than direct patient care (for example orthopedists buy MRI scanners and operating rooms, and internists sell vitamins and dietary aids); these can introduce new conflicts of interest.

Insurance monopsonies or monopolies often create unrealistic, non-negotiated fee schedules and impose costly administrative burdens on physicians. Even when competing health insurance physician contracts become strikingly similar, insurers operate with no fear of federal or state antitrust scrutiny. In fact, should a physician group try to resist the fees or other contract terms of one of these insurers, the insurer may threaten that physician group with antitrust prosecution! This is exactly the opposite of what antitrust laws were meant to do.

The AMA has identified more than 20 examples of DOJ/FTC enforcement efforts against physician groups trying to negotiate a contract from insurer(s) but cannot identify a single investigation of an insurance monopsony for fee fixing. How is this possible? The legal costs to fight antitrust allegations in a court trial are prohibitive; these cases often settle out of court by consent decree with the accused physicians agreeing to stop opposing the insurer. The insurer wins again.

An insurer need only call the DOJ or FTC to unleash a costly antitrust investigation. An antitrust investigation of the Federation of Physicians and Dentists (FPD) and orthopedic surgeons of Delaware in 1997 cost the FPD 1.5 million dollars and ended in a consent decree favorable to the physicians. An ongoing investigation of the orthopedists of Idaho DOJ investigation has so far wasted more than a million dollars in physician legal costs. As a labor union vice president, I was subpoenaed, deposed and most likely had my phones tapped by the Department of Justice for helping the Delaware orthopedists establish a third party messenger system to deal effectively with Blue Cross contract issues. Many physicians would prefer to change their medical specialization, retire, stop taking some or all insurance plans, or move rather than confront a health insurance monopoly or monopsony and face a financially punitive investigation by the DOJ.

The Sherman Antitrust Act of 1890 established consumer and small business protections from monopolistic corporate behavior. H.R.3596 will help restore the balance of interests among insurers, physicians and patients in the current health care delivery system and the next, consistent with the original intent of antitrust laws.

Thank you. I invite you to spend a day in my medical office or in the Yale Spina Bifida Clinic to observe first hand the problems doctors encounter practicing in America today.

Sincerely,

Michael P. Connair, M.D.