Collective Bargaining for Doctors Gains

The House early today approved legislation to grant doctors, dentists and other medical professionals the right to bargain collectively with insurers and HMOs, a measure that proponents claimed would help improve quality of care for patients but critics said would do little more than raise their premiums.

The 276-136 bipartisan vote represented a significant victory for the legislation’s chief sponsor, Rep. Tom Campbell of San Jose, the Republican nominee for Senate in California. It was the last House action before representatives began their Fourth of July recess.

Hours earlier, the Republican-controlled Senate on Thursday evening voted, 51 to 47, to endorse a limited set of new patient protections, including a restricted right for patients to sue their health maintenance organizations.

On his measure, HR 1304, Campbell faced significant challenges from key players within his own party’s leadership, who pushed the vote off until the wee post-midnight hours.

One proposed amendment to Campbell’s bill that the leadership allowed into the debate was denounced by abortion-rights supporters as a restriction on the ability of doctors to discuss abortion in negotiations with health plans. It was narrowly approved.

Campbell’s legislation would alter antitrust law to boost the negotiating position of medical professionals--and thereby, he hopes, give greater voice to patient advocates--at a time when companies that deliver managed care are consolidating and wielding great clout in the health care marketplace. If enacted, the measure would sunset after three years. Congress would then have to decide whether to renew the measure.

Under current law, doctors who are employed by a hospital or municipality may unionize. But most doctors may not join a union because antitrust laws ban collective bargaining when they are self-employed contractors. Campbell said his bill was not meant to unionize doctors and noted that it included a provision prohibiting strikes by covered medical professionals.

The American Medical Assn., representing doctors, strongly backed Campbell’s bill. The American Assn. of Health Plans and some key business groups just as strongly opposed it.

While the debate drew heated rhetoric from members of both parties, Campbell himself was restrained in his comments as he steered the measure through a series of procedural land mines.

A typical exchange with one critic who charged that doctors were only out to jack up their fees--and thereby pass on costs to consumers--ended with Campbell saying calmly, “If you want better quality of medicine, it might be that you have to pay for it.”

Proponents argued that giant health-care plans have too much power to dictate to doctors the terms under which they discuss and deliver care to patients.

“The health-care system has become David and Goliath, and we’ve got to give David something to fight with,” said Rep. Sheila Jackson-Lee (D-Texas).

But opponents said doctors were seeking to tilt the playing field in their own favor. Rep. John A. Boehner (R-Ohio) said doctors would “form a cartel to prey on American consumers.”

Before the debate began Thursday evening, Campbell, an antitrust expert and Stanford University law professor, had gained the backing of 220 House members as co-sponsors--a majority of the 435 representatives. Among the co-sponsors were 90 Republicans.

But the legislation now faces iffy prospects in the Senate, where major bills on other issues are backlogged in this election year.

In the end, the most significant result of the House vote could be the potential boost it would give to Campbell’s underdog campaign to unseat Sen. Dianne Feinstein (D-Calif.) in November.

For her part, Feinstein issued a sharply worded critique of the Campbell bill even though she has not taken a formal position on it.

“I believe that we will only see true health-care reform with passage of a meaningful ‘Patients’ Bill of Rights,”’ Feinstein said, referring to House-approved legislation that would regulate HMOs and give consumers broad rights to sue to enforce standards of care. Campbell voted against that legislation.