FTC Staff Comment Regarding Oregon Senate Bill 231A, Which Includes Language Intended To Provide Federal Antitrust Immunity To Conversations, Information Exchanges, and Agreements Among Participants (Including Competitors) In Oregon's Health Care Markets

UNITED STATES OF AMERICA
Federal Trade Commission
WASHINGTON, D.C. 20580
Office of Policy Planning
Bureau of Competition
Bureau of Economics
Northwest Regional Office
May 18, 2015
Senator Chip Shields
Oregon State Legislature
900 Court St. NE
Salem, Oregon 97301
Re: Request for Comment on Oregon Senate Bill 231A
Dear Senator Shields:
The staffs of the Federal Trade Commission’s (“FTC” or “Commission”) Office of Policy
Planning, Bureau of Competition, Bureau of Economics, and Northwest Regional Office1 are
pleased to respond to your request for comment on the potential competitive impact of Oregon
Senate Bill 231A (“SB 231A” or “the Bill”), including the purported need for a broad antitrust
exemption to enable the creation of alternatives to traditional fee-for-service payment models.2
The proposed Bill includes language intended to provide federal antitrust immunity for certain
conversations, information exchanges, and agreements among participants in Oregon’s health
care markets, some of whom may be competitors.
FTC staff fully recognizes that collaborations among health care providers, payers, and
other industry participants often are procompetitive. However, the broad antitrust exemptions
asserted in Section 4 of SB 231A are based on misunderstandings about the antitrust laws.
Antitrust exemptions are unnecessary to enable health care industry participants to
engage in procompetitive collaborative activities, such as enhancements to medical care delivery
sought through the development of a Primary Care Transformation Initiative (“PCTI”). As a
result, because procompetitive health care collaborations already are permissible under the
antitrust laws, the main effect of SB 231A would be to immunize joint conduct that likely would
restrain competition without generating countervailing efficiencies, and consequently would not
pass muster under the antitrust laws. Therefore, FTC staff respectfully suggests that the proposed
Bill is likely to lead to increased health care costs and decreased access to health care services
for Oregon consumers – results that would be contrary to the goals of the PCTI.
I. 	Interest and Experience of the Federal Trade Commission
Congress has charged the FTC with enforcing the Federal Trade Commission Act, which
prohibits unfair methods of competition and unfair or deceptive acts or practices in or affecting

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commerce.3 Competition is at the core of America’s economy,4 and vigorous competition among
sellers in an open marketplace gives consumers the benefits of lower prices, higher quality goods
and services, greater access to goods and services, and innovation.5 Pursuant to its statutory
mandate, the FTC seeks to identify business practices, laws, and regulations that may impede
competition without providing countervailing benefits to consumers.
Because of the importance of health care competition to the economy and consumer welfare,
anticompetitive conduct in health care markets has long been a key focus of FTC law
enforcement,6 research,7 and advocacy.8 Of particular relevance, the Commission and its staff
have long advocated against federal and state legislative proposals that seek to create antitrust
exemptions for collective negotiations, information exchanges, and other agreements among
health care providers, as such exemptions are likely to harm consumers.9
II. 	The Oregon Primary Care Initiative and SB 231A
SB 231A was introduced in the Regular Session of the 78th Oregon Legislature Assembly
and passed by the Senate on April 23, 2015.10 FTC staff commends the underlying goal of the
Bill: to study and improve the delivery of primary care services to Oregon health care
consumers. The Bill directs the Oregon Health Authority to convene a primary care payment
reform collaborative to advise and assist in the development of a PCTI. The collaborative will
“develop and share best practices in technical assistance and methods of reimbursement that
direct greater health care resources and investments toward supporting and facilitating health
care innovation and care improvement in primary care.”11 The PCTI will include representatives
from throughout the industry.12 The Bill also provides for data collection regarding the
proportion of medical expenses that Oregon insurers, benefit boards, and Coordinated Care
Organizations allocate to primary care, and requires information on how the benefit boards and
Coordinated Care Organizations pay for primary care.
Section 4(1) of the Bill declares that “collaboration among insurers, purchasers and providers
of health care to coordinate service delivery systems and develop innovative reimbursement
methods in support of integrated and coordinated health care delivery is in the best interest of the
public.”13 This section continues:
The Legislative Assembly therefore declares its intent to exempt from state antitrust
laws, and to provide immunity from federal antitrust laws through the state action
doctrine, any person participating in the Primary Care Transformation Initiative,
described in section 2 of this 2015 Act, that might otherwise be constrained by such
laws.14
Further, Section 4(3) permits certain groups of industry participants and other
stakeholders to meet to facilitate development, implementation, or operation of the PCTI, and
Section 4(4) allows certain surveys of the same parties to assist in the evaluation of the PCTI.
Section 4(5) purports to grant antitrust immunity for any meeting or survey covered by Section
4(3) or 4(4).

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Section 4(2) directs the Director of the Oregon Health Authority to “engage in
appropriate state supervision” “as necessary” to promote state action immunity.15
III. 	Concerns Regarding Potential Anticompetitive Effects of Oregon SB 231A
Putting aside the issue of the sufficiency of state oversight, FTC staff is concerned that
the purported antitrust immunity provided by SB 231A may facilitate joint negotiations between
providers and payers, encourage the exchange of competitively sensitive information among
industry participants, and encourage other agreements that may harm competition and
consumers. A broad antitrust exemption, such as the one apparently contemplated by SB 231A,
is not needed to fulfill the otherwise procompetitive and beneficial goals of the PCTI.
A. The Purported Antitrust Exemption in SB 231A is Unnecessary
Because the Antitrust Laws Already Permit Efficient Health Care
Collaborations
The inclusion of the purported antitrust exemption in SB 231A is based on two
fundamentally flawed premises: first, that efficient, procompetitive collaborations among
otherwise independent health care providers or other competitors are prohibited under the
antitrust laws; and second, that blanket antitrust immunity is necessary to encourage such
collaborations.
The antitrust laws already recognize and, indeed, have long stood for the proposition that
procompetitive collaborations among competitors do not violate the antitrust laws. As explained
in numerous sources of guidance issued by the federal antitrust agencies,16 this position extends
to collaborations among competing health care providers. FTC officials recently have
emphasized that “[t]he FTC supports the key aims of health care reform, and . . . recognize[s]
that collaborative and innovative arrangements among providers can reduce costs, improve
quality, and benefit consumers. But these goals are best achieved when there is healthy
competition in provider markets fostering the sort of dynamic, high-quality, and innovative
health care that practitioners seek and patients deserve.”17 The federal antitrust agencies have
challenged very few of the thousands of mergers, joint ventures, and other types of
collaborations among health care providers that have occurred in recent years. When the federal
antitrust agencies have done so, they have “brought those challenges only after rigorous analysis
of market conditions showed that the acquisition was likely to substantially lessen
competition.”18
These same principles extend to meetings, surveys, and other forms of information
exchange among competitors – many of which yield efficiencies and satisfy procompetitive
goals, and therefore do not run afoul of the antitrust laws. For example, providers can use
information derived from exchanges to price services more competitively or to offer
compensation that attracts quality employees.19 In fact, in their joint Statements of Antitrust
Enforcement Policy in Health Care, the antitrust agencies have articulated an “Antitrust Safety
Zone” for exchanges of price and cost information among providers that will not be challenged,
absent extraordinary circumstances.20 Similarly, procompetitive information exchanges by

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purchasers can allow for more informed purchasing decisions.21 At the same time, without
appropriate safeguards, information exchanges among competitors can facilitate collusion.
Moreover, the goals of antitrust are consistent with the goals of the Patient Protection and
Affordable Care Act (“ACA”)22 and Oregon’s new PCTI. Antitrust is not a barrier to health care
providers and other industry participants who seek to form procompetitive collaborative
arrangements and transform health care delivery in ways that are likely to reduce costs and
benefit health care consumers through increased efficiency, improved coordination of care, and
greater innovation.
B. Antitrust Exemptions That Immunize Otherwise Anticompetitive
Conduct Pose a Substantial Risk of Consumer Harm and Are
Disfavored
Because antitrust law permits procompetitive collaborations and information exchanges
among health care providers, no special “exemption” or “immunity” from existing antitrust laws
is necessary to ensure that such procompetitive collaborations or information exchanges occur.
The U.S. Supreme Court recently reiterated its long-standing position that “the antitrust laws’
values of free enterprise and economic competition” make such special exemptions or
immunities “disfavored.”23 There is no reason to treat the health care industry differently with
regard to application of the antitrust laws. In the health care industry, just like in other industries,
consumers benefit from vigorous competition and are harmed by anticompetitive conduct.24
Health care providers have repeatedly sought antitrust immunity for various forms of
joint conduct, including agreements on the prices they will accept from payers, asserting that
immunity for joint bargaining is necessary to level the playing field so that providers can create
and exercise countervailing market power.25 In a 2004 report on health care competition, the
federal antitrust agencies jointly responded to and countered this argument, explaining that
antitrust exemptions “are likely to harm consumers by increasing costs without improving
quality of care.”26 In its 2007 report, the bipartisan Antitrust Modernization Commission
succinctly stated a widely recognized proposition: “[t]ypically, antitrust exemptions create
economic benefits that flow to small, concentrated interest groups, while the costs of the
exemption are widely dispersed, usually passed on to a large population of consumers through
higher prices, reduced output, lower quality and reduced innovation.”27 In other words, antitrust
exemptions threaten broad consumer harm while usually benefitting only a relatively few market
participants.
Furthermore, FTC officials have noted that state legislation aimed at exempting health
care providers engaging in collaborative activities from antitrust scrutiny may “encourage
providers to negotiate collectively with health plans in order to extract higher rates, in effect
allowing providers to fix their prices. By permitting conduct that would ordinarily violate
antitrust laws, the bills would lead to higher prices and lower-quality care – undercutting the very
objectives they aim to achieve.”28 While FTC officials have acknowledged that “[c]ollaboration
designed to promote beneficial integrated care can benefit consumers,” they also have warned
that “collaboration that eliminates or reduces price competition or allows providers to gain
increased bargaining leverage with payers raises significant antitrust concerns. Antitrust

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concerns can arise if integration involves a substantial portion of the competing providers of any
particular service or specialty[.]”29 SB 231A appears so broad as to invite competitors and other
interested persons in any area of the state to exchange all manner of competitively sensitive
information – perhaps even including current and future pricing information – which could
facilitate or enable providers to increase the price and reduce the supply of health care services
and goods. Indeed, SB 231A may even insulate unintegrated health care providers from liability
for engaging in concerted negotiations with payers.
Given that efficient collaborations and information exchanges among health care
providers (or other competitors) that are likely to benefit consumers already are consistent with
the antitrust laws, FTC staff is concerned that SB 231A will encourage precisely the types of
agreements among competitors that likely would not pass muster under the antitrust laws –
agreements that would reduce competition, raise prices, and provide few or no benefits to
consumers. Any effort to shield such harmful agreements from antitrust enforcement, including
attempts to confer state action immunity, is likely to harm Oregon health care consumers.
IV. 	Conclusion
In summary, FTC staff not only believes that the antitrust exemptions contemplated in SB
231A are unnecessary to promote the goals of health care reform, but also is concerned that the
purported exemptions are likely to foster anticompetitive conduct to the detriment of Oregon
health care consumers. Therefore, we urge the Oregon legislature to reconsider whether SB
231A is in the public interest.
The FTC will continue to investigate and challenge transactions that are anticompetitive.
In addition, we will continue to challenge defenses based on asserted state action immunity
where the state fails to provide adequate active supervision.
Respectfully submitted,
Marina Lao, Director
Office of Policy Planning
Deborah L. Feinstein, Director
Bureau of Competition
Francine Lafontaine, Director
Bureau of Economics
Charles A. Harwood, Director
Northwest Regional Office

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1 This letter expresses the views of the FTC’s Office of Policy Planning, Bureau of
Competition, Bureau of Economics, and Northwest Regional Office. The letter does not
necessarily represent the views of the Commission or of any individual Commissioner. The
Commission has, however, voted to authorize staff to submit these comments.
2 Letter from Chip Shields, Senator, Or. State Legislature, to Marina Lao, Dir., Office of Policy
Planning, Fed. Trade Comm’n (Apr. 30, 2015).
3 Federal Trade Commission Act, 15 U.S.C. § 45.
4 Standard Oil Co. v. FTC, 340 U.S. 231, 248 (1951) (“The heart of our national economic
policy long has been faith in the value of competition.”).
5 See Nat’l Soc. of Prof. Eng’rs v. United States, 435 U.S. 679, 695 (1978) (The antitrust laws
reflect “a legislative judgment that ultimately competition will produce not only lower prices,
but also better goods and services. . . . The assumption that competition is the best method of
allocating resources in a free market recognizes that all elements of a bargain – quality,
service, safety, and durability – and not just the immediate cost, are favorably affected by the
free opportunity to select among alternative offers.”).
6 See generally FED. TRADE C OMM’N, O VERVIEW OF FTC ANTITRUST ACTIONS IN HEALTH C ARE
S ERVICES AND P RODUCTS (Mar. 2013), https://www.ftc.gov/sites/default/files/attachments/
competition-policy-guidance/hcupdate.pdf. See also Competition in the Health Care
Marketplace, FED. TRADE C OMM’N, https://www.ftc.gov/tips-advice/competition-
guidance/industry-guidance/health-care (“Cases”).
7 See, e.g., FED. TRADE C OMM’N & U.S. DEP ’ T OF J USTICE, IMPROVING HEALTH C ARE: A DOSE
OF C OMPETITION (2004), https://www.ftc.gov/sites/default/files/documents/reports/improving-
health-care-dose-competition-report-federal-trade-commission-and-department-justice/
040723healthcarerpt.pdf. The report was based on, among other things, 27 days of formal
hearings on competitive issues in health care, an FTC sponsored workshop, independent
research, and the Agencies’ enforcement experience. See also FTC-DOJ workshop series,
Examining Health Care Competition, Mar. 20-21, 2014 and Feb. 24-25, 2015,
https://www.ftc.gov/news-events/events-calendar/2015/02/examining-health-care-
competition.
8 FTC and staff advocacy may comprise letters or comments addressing specific policy issues,
Commission or staff testimony before legislative or regulatory bodies, amicus briefs, or
reports.
9 See, e.g., FTC Staff Comment to the Center for Health Care Policy and Resource
Development on Certificate of Public Advantage Applications under the Delivery System
Reform Incentive Program (Apr. 2015), https://www.ftc.gov/system/files/documents/
advocacy_documents/ftc-staff-comment-center-health-care-policy-resource-development-
office-primary-care-health-systems/150422newyorkhealth.pdf; FTC Staff Comment to Sen.
Catherine Osten and Rep. Peter Tercyak, Conn. Gen. Assembly, Concerning H.B. 6431,
Intended to Exempt Health Care Collaboratives from the Antitrust Laws (June 2013),
https://www.ftc.gov/sites/default/files/documents/advocacy_documents/ftc-staff-comment-
connecticut-general-assembly-labor-and-employees-committee-regarding-
connecticut/130605conncoopcomment.pdf; FTC Staff Comment to Sen. John J. Bonacic, N.Y.
State Senate, Concerning N.Y. Senate Bill S.3186-A, Intended to Permit Collective

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Negotiations by Health Care Providers (Oct. 2011), https://www.ftc.gov/
sites/default/files/documents/advocacy_documents/ftc-staff-comment-honorable-john-
j.bonacic-concerning-new-york-s.b.3186-allow-health-care-providers-negotiate-collectively-
health-plans/111024nyhealthcare.pdf; FTC Staff Comment to Sens. Coleman and Kissel and
Reps. Fox and Hetherington, Conn. Gen. Assembly, Concerning Connecticut H.B. 6343,
Intended to Exempt Members of Certified Cooperative Arrangements from the Antitrust Laws
(June 2011), https://www.ftc.gov/sites/default/files/documents/advocacy_documents/ftc-staff-
comment-senatorscoleman-andkissel-and-representativesfox-and-hetherington-
concerning.b.6343intended-toexempt-members-certified-cooperative-arrangements-antitrust-
laws/110608chc.pdf; FTC Staff Comment to the Hon. Elliott Naishtat Concerning Tex. S.B. 8
to Exempt Certified Health Care Collaboratives from the Antitrust Laws (May 2011),
https://www.ftc.gov/sites/default/files/documents/advocacy_documents/ftc-staff-comment-
hon.elliot-naishtat-concerning-texas-s.b.8-exempt-certified-health-care-collaboratives-
antitrust-laws/1105texashealthcare.pdf; FTC Staff Comment to Rep. Tom Emmer of the
Minn. House of Reps. Concerning Minn. H.F. No. 120 and Senate Bill S.F. No. 203 on Health
Care Cooperatives (Mar. 2009), https://www.ftc.gov/sites/default/files/documents/
advocacy_documents/ftc-staff-comment-representative-tom-emmer-minnesota-house-
representatives-concerning-minnesota-ok-h.f.no.120-and-senate-bill-s.f.no.203-health-care-
cooperatives/v090003.pdf; FTC Staff Comment to the Hon. William J. Seitz Concerning Ohio
Executive Order 2007-23S to Establish Collective Bargaining for Home Health Care Workers
(Feb. 2008), https://www.ftc.gov/sites/default/files/documents/advocacy_documents/ftc-staff-
comment-hon.william-j.seitz-concerning-ohio-executive-order-2007-23s-establish-collective-
bargaining-home-health-care/v080001homecare.pdf; FTC Staff Comment before the P.R.
House of Reps. Concerning S.B. 2190 to Permit Collective Bargaining by Health Care
Providers (Jan. 2008), https://www.ftc.gov/sites/default/files/documents/
advocacy_documents/ftc-staff-comment-puerto-rico-house-representatives-concerning-
s.b.2190-permit-collective-bargaining-health-care-providers/v080003puerto.pdf. All
advocacies are available at https://www.ftc.gov/policy/advocacy/advocacy-filings.
10 For more information on SB 231A and the Primary Care Transformation Initiative, see
Oregon Health Authority Measure Summary, http://www.oregon.gov/oha/legactivity/
SB%20231%20%28PC%20transformation%29%20one-pager%201.21.15.pdf.
11 S.B. 231A, Section 2(2), 78th Leg. Assemb. (Or. 2015).
12 Id. at Section 2(3).
13 Id. at Section 4(1).
14 Id.
15 States may provide private actors or state agencies controlled by regulated persons with
antitrust immunity for certain activities when there is a clearly articulated state policy to
displace competition and there is active state supervision of the policy or activity. See Parker
v. Brown, 317 U.S. 341 (1943), FTC v. Phoebe Putney Health Sys., Inc., 133 S. Ct. 1003
(2013), and North Carolina State Bd. Of Dental Exam’rs v. FTC, 135 S. Ct. 1101 (2015). FTC
staff takes no position at this time on whether SB 231A or the PCTI, as implemented, would
satisfy the active supervision prong of the state action doctrine.

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16 To assist the business community in distinguishing between lawful and potentially harmful
forms of competitor collaboration, the FTC and its sister federal antitrust agency, the DOJ,
have issued considerable guidance over the years. Key sources of guidance include the
Agencies’ general guidelines on collaborations among competitors, as well as joint statements
specifically addressing the application of the antitrust laws to the health care industry,
including physician network joint ventures and other provider collaborations. See F ED. TRADE
C OMM’N &U.S. DEP ’ T OF J USTICE, ANTITRUST GUIDELINES FOR C OLLABORATIONS A MONG
C OMPETITORS (2000), https://www.ftc.gov/system/files/documents/public_statements/300481/
000407ftcdojguidelines.pdf; U.S. DEP ’ T OF J USTICE & FED. TRADE C OMM ’ N, S TATEMENTS OF
ANTITRUST ENFORCEMENT P OLICY IN HEALTH C ARE (1996) [hereinafter DOJ & FTC, HEALTH
C ARE S TATEMENTS ], https://www.ftc.gov/sites/default/files/documents/reports/revised-
federal-trade-commission-justice-department-policy-statements-health-care-
antritrust/hlth3s.pdf (Statement 8 regarding physician network joint ventures, Statement 7
regarding joint purchasing arrangements among providers of health care services, and
Statement 6 regarding provider participation in exchanges of price and cost information). In
addition, FTC staff has issued and made public numerous advisory opinion letters containing
detailed analyses of specific proposed health care collaborations. These letters have helped the
requesting parties avoid potentially unlawful conduct as they seek to devise new ways of
responding to the demands of the marketplace. They also have provided further guidance to
the health care industry as a whole. See, e.g., Letter from Markus H. Meier, Fed. Trade
Comm’n, to Michael E. Joseph, Esq., McAfee & Taft, Re: Norman PHO Advisory Opinion,
Feb. 13, 2013, https://www.ftc.gov/sites/default/files/documents/advisory-opinions/norman-
physician-hospital-organization/130213normanphoadvltr_0.pdf; Letter from Markus H.
Meier, Fed. Trade Comm’n, to Christi Braun, Ober, Kaler, Grimes & Shriver, Re: TriState
Health Partners, Inc. Advisory Opinion, Apr. 13, 2009,
https://www.ftc.gov/sites/default/files/documents/advisory-opinions/tristate-health-partners-
inc./090413tristateaoletter.pdf; Letter from Markus Meier, Fed. Trade Comm’n, to Christi
Braun & John J. Miles, Ober, Kaler, Grimes & Shriver, Re: Greater Rochester Independent
Practice Association, Inc. Advisory Opinion, Sept. 17, 2007,
https://www.ftc.gov/sites/default/files/documents/advisory-opinions/greater-rochester-
independent-practice-association-inc./gripa.pdf.
17 Edith Ramirez, Antitrust Enforcement in Health Care – Controlling Costs, Improving Quality,
371 NEW ENG. J. M ED. 2245 (2014), http://www.nejm.org/doi/pdf/10.1056/NEJMp1408009.
See also Deborah L. Feinstein, Dir., Bureau of Competition, Remarks at the Fifth National
Accountable Care Organization Summit in Washington, DC: Antitrust Enforcement in Health
Care: Proscription, not Prescription (June 19, 2014), https://www.ftc.gov/system/files/
documents/public_statements/409481/140619_aco_speech.pdf (“We continue to hear claims
that antitrust principles are at odds with the mandates of the Affordable Care Act. I believe
these arguments misunderstand the focus and intent of federal antitrust enforcement. . . . In the
final analysis, our actions make clear the important role of antitrust in health care policy.
Ultimately, we believe that the imperatives of developing lower cost, higher quality health
care can coexist with continued enforcement of the antitrust laws.”); Commissioner Julie
Brill, Fed. Trade Comm’n, Keynote Address at the Catalyst For Payment Reform 2013
National Summit on Provider Market Power: Promoting Healthy Competition in Health Care
Markets: Antitrust, the ACA, and ACOs (June 11, 2013), https://www.ftc.gov/sites/

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default/files/documents/public_statements/promoting-healthy-competition-health-care-
markets-antitrust-aca-and-acos/130611cprspeech.pdf.
18 Feinstein, supra note 17.
19 DOJ & FTC, HEALTH C ARE S TATEMENTS, supra note 16, at Statement 6 (regarding provider
participation in exchanges of price and cost information).
20 Id. at A.
21 Id.
22 Pub. L. No. 111-148, § 3022, 14 Stat. 119, 395 (“Affordable Care Act”).
23 FTC v. Phoebe Putney Health Sys., Inc., 133 S. Ct. 1003, 1010 (2013) (quoting FTC v. Ticor
Title Ins. Co., 504 U. S. 621, 636 (1992)). See also North Carolina State Bd. Of Dental
Exam’rs v. FTC, 135 S. Ct. 1101, 1117 (2015) (“The Sherman Act protects competition while
also respecting federalism. It does not authorize the States to abandon markets to the
unsupervised control of active market participants, whether trade associations or hybrid
agencies. If a State wants to rely on active market participants as regulators, it must provide
active supervision if state-action immunity under Parker is to be invoked.”).
24 Phoebe Putney, 133 S. Ct. at 1015 (state legislature’s objective of improving access to
affordable health care does not logically suggest contemplation of anticompetitive means, and
“restrictions [imposed upon hospital authorities] should be read to suggest more modest
aims.”). As the U.S. Court of Appeals for the Fourth Circuit has observed, “[f]orewarned by
the [Supreme Court’s] decision in National Society of Professional Engineers . . . that it is not
the function of a group of professionals to decide that competition is not beneficial in their
line of work, we are not inclined to condone anticompetitive conduct upon an incantation of
‘good medical practice.’” Va. Acad. of Clinical Psychologists v. Blue Shield of Va., 624 F.2d
476, 485 (4th Cir. 1980).
25 In general, the Supreme Court has flatly rejected the notion that members of the learned
professions should be free from antitrust scrutiny: “The nature of an occupation, standing
alone, does not provide sanctuary from the Sherman Act . . . nor is the public service aspect of
professional practice controlling in determining whether § 1 includes professions.” Goldfarb
v. Va. State Bar, 421 U.S. 773, 787 (1975). See also Nat’l Soc. of Prof. Eng’rs v. United
States, 435 U.S. 679, 695 (1978) (Supreme Court rejection of argument that competition itself
poses a “potential threat . . . to the public safety”); FTC v. Indiana Fed’n of Dentists, 476 U.S.
447 (1986).
26 FED. TRADE C OMM’ N & U.S. DEP ’ T OF J USTICE, IMPROVING H EALTH C ARE , supra note 7, at
14.
27 ANTITRUST M ODERNIZATION C OMM’ N, R EPORT AND R ECOMMENDATIONS 335 (2007),
http://govinfo.library.unt.edu/amc/report_recommendation/amc_final_report.pdf.
28 Ramirez, supra note 17.
29 Feinstein, supra note 17. There is a growing body of empirical research showing that
increased concentration among health care providers results in higher prices without offsetting
improvements in quality. See, e.g., Martin Gaynor & Robert Town, The Impact of Hospital
Consolidation – Update (Robert Wood Johnson Found., Synthesis Project Report, June 2012),
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf73261.