Cover

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pp. 1-1

Title Page, Copyright, Dedication, Quote

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pp. 2-9

Contents

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pp. ix-11

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Foreword

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pp. xi-xii

The Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. The Fund has engaged in nonpartisan...

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Preface

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pp. xiii-xv

Most nations of the world share similar goals concerning the provision of health care to their citizens—broad access, low costs, and high quality. But the means for achieving these goals can differ, particularly in the United States, where a market-based approach as opposed to a more centralized,...

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Introduction

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pp. 1-20

This book is about the health care revolution of the 1970s, which ended the medical monopoly in the United States and made a market-based health policy politically thinkable for the first time. It relates the events leading up to the revolution and the use of federal antitrust laws to help bring it about....

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1. The Professional Regime

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pp. 21-41

This chapter traces the evolution of the medical profession from the late 1800s to the mid-twentieth century. Three questions frame the discussion: What factors gave rise to medicine’s professional regime? How did the regime exercise its authority? What role did the antitrust laws play in the...

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2. Precursors of Change

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pp. 42-58

The social climate of the post–World War II years reveals a steady erosion of support, not for the professional ideal, but for professional associations and their interest-group tactics. Critics emphasized excessive fees, indifference to the personal concerns of patients, attacks on chiropractors, osteopaths, and...

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3. The Triumph of Market Theory

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pp. 59-77

The transition from regulatory policy to competition policy in the late 1970s, though seemingly abrupt, followed years of preparation and accumulated knowledge in academic and policy circles. As political scientist John Kingdon observed, “Agenda change appears quite discontinuous and nonincremental...

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4. The Federal Trade Commission Takes the Lead

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pp. 78-99

The lead agency in the fight against the anticompetitive practices of the medical profession was the Federal Trade Commission. This chapter sets the stage for the agency’s initial confrontation with the AMA, addressed in the next chapter, and the series of investigations, probes, and administrative actions...

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5. The AMA Case

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pp. 100-118

The crowning achievement of the FTC’s early campaign for a more competitive environment in the health care industry was its case against the AMA (In the Matter of the American Medical Ass’n, 94 F.T.C. 701 [1979]). Begun in 1975, the AMA case targeted ethical restrictions on physician...

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6. A Question of Jurisdiction

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pp. 119-134

Because a ruling of an administrative law judge is subject to internal review, it does not represent the final decision of an administrative agency. Though Michael Pertschuk and his fellow commissioners could reverse Judge Barnes’s proposed order, they were not likely to do so, despite threatened...

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7. Drawing the Line between Clinical and Business Practices

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pp. 135-154

Viewed in historical context, the early health care agenda of the FTC was bold, even radical, in design. It reflected the preferences of its chief architects, Clark Havighurst and Jim Liebeler, and the prominent position of the FTC in the policy-making community in the mid-1970s. The main focus of...

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8. The Quest for Antitrust Relief

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pp. 155-172

The application of the antitrust laws to the medical profession spurred a structural transformation of the health care industry. New forms of finance and delivery emerged that medical societies previously had prohibited. Equally important, moreover, was the effect on physicians’ practices. By...

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9. The Demonization of Managed Care

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pp. 173-195

Rolling back the antitrust laws as they applied to physicians proved to be a difficult undertaking. A special exemption for collective bargaining or the relaxation of enforcement standards for physician joint ventures required the acquiescence of Congress or the federal antitrust agencies. The health...

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Conclusion

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pp. 196-209

The 1890 Sherman Act became America’s gospel of free enterprise, its “second constitution.” On initial inspection, the act appeared to embody the principles of laissez faire, the policy of relying on competitive markets to guide economic development and to protect consumer interests. But, like the...

References

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pp. 211-229

Index

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pp. 231-253

Production Notes

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pp. 254-271