In a truly breathtaking display of contempt for the American electorate, the House of Representatives has voted 245-155 to exempt doctors, dentists, and similar professionals from regulation by the Federal Trade Commission. This lopsided vote occurred despite the publicity surrounding the campaign contributions lavished on Congress by the affected professions, and despite the fact that the House was put on notice that this vote would demonstrate whether it is for sale.
In the end, $2.8 million from political action committees of the American Medical Association and the American Dental Association spoke louder than opposition from the Reagan administration, a bipartisan coalition in Congress and a broad coalition of consumer and health care groups. These parties had brokered a compromise that retained FTC jurisdiction over the commercial aspects of these professions and gave licensing jurisdiction to the states, but when the voting was over the professions were exempted from all FTC regulation.
"It's remarkable," says Henry Waxman, (D-Calif.), chairman of the health subcommittee and an opponent of the exemption, "that the AMA was able to prevail over a strong, bipartisan coalition that developed a compromise that met all of the public statements that the AMA and other professions made as to why we needed some changes in the FTC's authority to deal with them. What the AMA really wanted was... a way of keeping the FTC from looking at any issues of eliminating competition where doctors were involved. I think their campaign contributions played an enormous role in their victory."
The Senate, which has been the beneficiary of nearly $800,000 from AMA and ADA PACs, is expected to vote on deregulating the professionals this week. Unless it shows more integrity than the House did, the only protection the public will have against price-fixing and other monopolistic practices by the professions will be the antitrust division of the Justice Department (which hasn't brought an antitrust suit against professionals since 1973) and state boards, which are often composed of members of the profession. The AMA contends this is sufficient, but the National Association of State Attorneys General, citing the FTC's "greater expertise," voted almost unanimously that it continue regulating professions.
Most area representatives backed the AMA positions. According to Congress Watch, a public interest group that monitors Capitol Hill activities, most of those congressmen also received thousands from the AMA and ADA PACs, ranging from a low of $6,000 for Roy Dyson (D-Md.) to a high of $24,000 for Frank Wolf (R-Va). Exceptions were Rep. Michael Barnes (D-Md.) and Steny Hoyer (D-Md.), who received $900 and $1,350 respectively. Barnes voted against limiting any FTC jurisdiction. Hoyer voted to lift all FTC jurisdiction, saying through a press aide that Maryland had developed an effective cost review commission and he thought other states should have the same opportunity.
Rep. Thomas Downey (D-N.Y.) says the relationship between money and votes is "direct, obvious and it's insidious.... What they've bought is unlimited access and that access allows them to come in and present their cause completely. The other side is a letter from (a public interest group such as) Common Cause. That's never going to be as convincing to the people who are supposedly sitting on the fence....
"I wish there was a climate in America that was outraged by the amount of money funneled into political campaigns. Here is a Congress consumed by the cost of health care but not so consumed that they're going to force doctors into the next step of having to compete with one another. The contradictions abound."
At stake for the American consumer is access to a competitive marketplace when shopping for such items as health, veterinary, dental and legal care. At stake for the professionals is their ability to shut out competition from nurse-midwives, to ban advertising in their profession, to arrange kickbacks with laboratories, to fix prices, to boycott health cost containment programs and to ban doctors who work for them from hospitals.
These are items on a long list of anticompetitive activities that the FTC has tried to stop. Unless the Senate repudiates the House, the AMA and ADA will have succeeded in buying their way out from under the rules that govern all other businessmen, and the public will have lost a valuable watchdog in the struggle to curb health care costs.