Since many of the independent physicians of Utah have mounted an all-out campaign opposing the Federal Trade Commission's decision to force the divestiture of three hospitals in the HealthTrust/Columbia/
RCA merger, something seems to have been lost in the minds of many people. As we have attempted to garner support from the city councils of communities that would be most affected by this decision, some members of those councils, and also some in the media, have falsely assumed and stated that this is a deal about money only, and that the argument here is between two hospital corporations, the other being Intermountain Health Care.The physicians actively opposing the Federal Trade Commission have no particular love for HealthTrust or Columbia/HCA. As far as we are concerned, corporate medicine is little more than a necessary evil. We recognize that mergers like this take place largely so that someone can make money. But since the majority of physicians affiliated with these facilities are independent, they stand to gain nothing financially in a direct sense from the proposed merger.
The physicians involved would like to maintain their patient base. and in today's health-care environment, particularly in Utah, this necessitates that they be at least loosely affiliated with an organization with a broad geographic coverage, namely a hospital network. Such a network, and its geographic coverage, allows for competition in the obtaining of large employer contracts. Those who will suffer most, if the current FTC ruling holds, will actually be our patients, whose long-term relationships with their physicians may be jeopardized by changing affiliations of their insurance companies with different hospital chains, and by a limited choice.
The Federal Trade Commission cites the possibility, in the long-term, of collusion between two major health-care players in a marketplace to fix or raise prices, and thus harm the public. This is analogous to putting handcuffs on a 5-year-old boy because of the possibility that he may steal something as a teenager. I suppose this should not surprise us in the 1990s, when other agencies of the federal government, for example the IRS. take the view that one is guilty until proven innocent.
The real issue here, not only for the physicians involved but for the public, is the inconsistency of the antitrust laws. Current antitrust legislation allows for the building of a virtual monopoly, such as the empire that Intermountain Health Care has created, in which they have captured a 55 percent market share in the state. The same laws do not allow for the acquisition of existing facilities that would create a network capable of controlling one-half of the hospital beds currently controlled by Intermountain Health Care.
Lastly, does anyone have a better idea (other than the proposed merger) that would allow for fair competition among health-care providers in Utah and thus lower costs? If so, I hope it is not the false notion that the creation of two independent, integrated delivery systems could provide cost effective, quality health care better than one. If this were the case, the Sisters of the Holy Cross, who provided hospital care in this state for 115 years, would still be doing so, instead of being virtually forced to sell out and thus have their facilities become part of a bigger system.
Meanwhile, while our friends at the Federal Trade Commission try to force non-IHC hospitals and physicians to compete with each other. IHC's market share continues to grow for obvious reasons: They have no true competition.
The commission's ruling, which is anti-competitive, would ultimately limit our choice of, and access to, health-care providers, and also be bad economic news for all of us.
Kevin B. Johnson, M.D.