Introduction: Antitrust and Health Care

Health care markets and related sectors of the economy like insurance provide essential services in our society. They have been undergoing rapid change for at least the past decade, yet some thirtyseven to thirty-nine million citizens lack health care insurance at one time or another each year; rapid inflation of costs has more often been the case than not; and equal access to the system for both consumers and providers is too often the exception rather than the rule. Despite the reality that Congress has not adopted major legislation reforming health care, reform continues to take place. Whether that reform will be constructive or whether it will make matters worse for both providers and consumers is by no means clear. Reform is taking place in the context of regulation through the constraints placed upon the exercise and enforcement of private contract and property rights by special state legislation and state and federal antitrust laws. The most basic and fundamental state and federal laws governing the private sector of the economy have been and will likely continue to be the antitrust laws. Whether the changes now taking place will benefit all consumers, provide competitors equal access to markets, and enhance or retard allocative, productive, and innovative efficiencies, may well depend upon whether and how the antitrust laws influence and direct the change taking place. In the absence of viable and comprehensive legislative alternatives being adopted in the near future, antitrust policy will continue to be the primary force shaping health care reform.1