BW: Good morning John.
JR: Well, the question of anti-trust, any general comments and then I could get into specifics I might have? First to the average mental health practitioner, it’s hard to conceptualize what anti-trust is. We think of that’s what they go after Bill Gates and Microsoft. How does it apply to us?
BW: Well it does apply to us in fact the attorney for the Federal government, Joel Kline the attorney going after Microsoft, was also the attorney in the Psychoanalytic litigation. We had an anti-trust suit filed against them to try to open their training to psychologists and social workers across the country. So there is a connection and the same rules and principles do apply.
But let me just say that the idea behind the antitrust laws is to promote competition throughout the economy and that includes the mental health field.
The theory behind our free enterprise system is if you have many competing in the market place it going to lead to lower prices and it will lead to better products. In order to sell you need a good product at a lower price. So the theory behind the anti-trust laws is that’s the kind of economic system we want to have.
Now what we have discovered and the reason behind the anti-trust laws particularly in the 1890s is that some companies were becoming so powerful in the economic system that they were able to drive out competition. And there were a number of ways they did that. They might get control of a crucial ingredient you needed to produce a product or they might be able to hold prices down until the competition died out and then have a complete monopoly. Or they could threaten suppliers that if they sold products to a competitor they would not deal with them. That would of course drive competitors out of the market place.
The anti-trust laws are designed to prevent those kinds of abuses. There are designed ironically or paradoxically for the government to step in and regulate the economy enough that we maintain the kind of competitive balance to obtain the benefits of lower prices and higher quality goods.
JR: Yes, well I think that is what we all received from our high school and college civics. I think or at least what I have observed is that it hard for the average private practicing psychologist, social worker etc. to make that connection as it applies to them. I can understand it, but I can also see that it’s a difficult jump. We see ourselves as the little guy. We’re not big corporations. In fact some of us are fighting for our very existence against the big managed care companies. It feels as if the anti-trust laws are turned around on their head. Can you clarify a bit?
BW: Yea, I can certainly understand the feeling full well. The problem we run into is we still have to play by the rules of the game and the main way in which I see practitioners potentially getting into trouble in today’s health care delivery system is caused by their reaction to managed care.
Now as you know I. believe managed care and it’s not much of a hyperbole to say that it has made it almos impossible to get high quality mental health care particularly if you need more than 5 or 6 therapy visits with someone Nonetheless the anti-trust laws apply to us as well as anyone else in the economy.
One of the things we cannot do is we cannot encourage our colleagues to participate in what’s called a group boycott. That is we can not get online or in our professional organization and say, Hey the way we can deal what managed Care Company X, which is truly awful, is – to simply all agree to not do business with them. In that way we are going to force them to improve benefits or pay a higher fee. That what’s we can’t do. That’s using our economic power, limited though we may feel it is, to reduce their access to critical ingredient that need to participate in the economic system.
The second thing we cannot do is price fix. We cannot get together and say, look if we all keep competing with each other, like in the milk wars and lower prices we all lose. Let’s just agree to charge $130 and hour and let that be the standard fee.
That is an absolute “no- no” under the anti-trust laws. And if you think about the reason for them, it makes sense. You can’t go in and simply decide that we are going to subtract the competition from the market place that we participate in because the consumer loses. The consumer loses the benefit of having us compete with one another for lower fees and hopefully better services that we have to offer.
So those are the two kinds of things we cannot do.
JR: Now would it help clarify if we looked at this in terms of buyers and sellers? My understanding is and tells me if I am understanding it correctly is that basically anti-trust laws protect buyers. In effect when we deal with consumers or managed care companies we are sellers. The buyer can choose to agree collectively to buy or not.
Hightlights of Interview With Dr. Welch
Audio Interview with Dr. Welch
