I Advocates of the Campbell bill believe that even though practitioners may be self-employed, the insurance industry has such great power over their livelihood and professional decision-making process that they are de facto employees and should have negotiating rights.
Dentists involved in collective bargaining with insurers? Not today! But that could quickly change. Faced with perceived third-party intrusions into patient/dentist relationships, dentists are supporting actions that will help maintain the integrity of this critical practice component.
One such response has been the ADA’s support of the Quality Health Care Coalition Act of 2000, also known as the Campbell bill (HR 1304). Embraced by the American Medical Association and representatives of other health professions, this bill sought to improve patient care through federal legislation that would give self-employed practitioners the right to negotiate collectively with insurers and other health plan administrators.
This endorsement did not signal a new policy direction for the ADA. Approval for the concept of collective bargaining rights for dentists can be traced to a 1994 ADA House of Delegates action that advocated for changes in federal antitrust laws.
The Campbell bill, which had strong bipartisan backing, gained overwhelming approval in the U.S. House of Representatives. However, lack of a companion bill in the U.S. Senate erased its opportunity to be adopted into law during the 2000 legislative session.
It is gone—but definitely not forgotten.
Advocates of the Campbell bill want to ensure that the concepts of collective bargaining expressed in past legislation will be resurrected in future law-making activities. They believe that even though practitioners may be self-employed, the insurance industry has such great power over their livelihood and professional decision-making process that they are de facto employees and should have negotiating rights.
The present antitrust laws say no! Indeed, dentists who inadvertently have become involved in collective bargaining attempts have paid a stiff legal and financial price.
Any new legislation will have its opponents. The insurers will continue to oppose any bill that would give practitioners the right to bargain. Two previous detractors of the Campbell bill, the Federal Trade Commission and the U.S. Department of Justice, suggest patient protection legislation as a preferable way to address the patient/provider concerns.
Within the dental profession, new and emerging information may slow or alter policies that favor collective bargaining.
Legally, collective actions that don’t precisely follow the letter of the law could place practitioners in serious legal difficulty. Under I Campbell-type legislation, dentists considering participating in collective bargaining activities might, by necessity, incur significant administrative costs. Conceivably, some dentists may not be willing to pay these costs, thereby creating schisms that negatively alter professional relationships.
Dental economists also mention some potentially serious fiscal concerns regarding the impact of dental collective bargaining. For example, unlike medicine, in which catastrophic insurance is considered a must, acceptance or maintenance of dental insurance plans often is discretionary and exceedingly price-sensitive.
There is concern that increases in reimbursement fees achieved through collective bargaining might have adverse consequences on dental plans. Faced with increased costs, the insurer could pass the fee increases directly to the plan’s sponsors, who might reduce benefits or even eliminate the program.
The economists also point out that the environment for collective bargaining, with its organizational costs and unknown impact on payment plans, may be less necessary in dentistry than in medicine, which derives 85 percent of its payments from insurers. Dentistry, in which less than 50 percent of payment is derived from insurers, is less susceptible to the adverse impact of fee discounts.
Organized dentistry knows that the passage of collective bargaining legislation would open the door for unions to solicit the self-employed dentist. Their other benefits notwithstanding, dentists paying union dues might not continue their ADA membership. New dental graduates might not join. And any serious reduction in the number of ADA members could severely weaken the ADA’s legislative, educational and scientific agendas.
Finally, there is a question as to how the public would regard unionized dentists who were depicted as "greedy" tradespeople by their third-party adversaries. Would just a few dentists’ becoming unionized paint the entire profession with that brush? Would dentistry be viewed as a trade rather than a profession?
Last year, the AMA voted to endorse a medical union that could represent more than 100,000 employed physicians in their negotiations with health plans, hospitals and universities. Monitoring the professional impact of that action, the JADA Question of the Month asked readers to comment on whether they thought the AMA unionization action would detract from physicians’ professionalism.1
We received an unprecedented large number of replies, equally divided between "yes" vs. "no" answers. Supporters of the AMA actions directed their comments to combating the power and money of the insurers. Phrases such as "it’s time to fight back" were constantly noted. The underlying theme was that medicine’s professionalism already had been compromised by insurance companies, so physicians had nothing to lose by unionizing.
Those who felt that unionization would compromise professionalism thought the AMA action was "stupid"—that unionized "rich doctors" would appear as a bunch of self-serving, money-hungry professionals.
If a bill similar to the Campbell bill is introduced in the next Congress, the AMA surely will support it. Collective bargaining is a critical companion piece to the AMA’s previous union action.
Organized dentistry’s future position is not as clear. With the need for collective bargaining not nearly as established as it is in medicine, some are saying, "Let’s reevaluate before we go forward." Others contend that strong patient protection legislation could solve some of the pressing dentist/patient concerns, thus negating the need to seek collective bargaining rights.
The "let’s-go-for-it-all" group wants both patients’ rights legislation and collective bargaining. They point out that even though the Campbell bill did not emerge from this Congress, it has served notice to the insurance companies that members of the health professions value their patient/ provider relationships and will use appropriate legislation to preserve and defend them.
Legislation to provide self-employed health professionals with the right to participate in collective bargaining presently sits on the congressional back burner—but not for long. Ultimately, dentistry will have to decide how it will proceed.
Only a knowledgeable and vocal ADA membership can ensure that its leaders make the correct decision.
