Something Happened
We all owe a debt to the dentists in Indiana. For many years, they have shown more awareness of the implications of a number of political, social, and economic policies and procedures than others have, and they have staunchly advocated their positions in the House of Delegates and councils of the ADA. They have often been at odds with " the establishment" and have sponsored a number of losing causes. But they have hung in there and continued to fight for what they believe to be in the best interest of the public and the profession.
Nowhere is their devotion to that principle more evident than in their continued battle with the Federal Trade Commission over the procedure whereby dental insurance carriers may require submission of dental x-rays and question a dentist's diagnosis on the basis of those x-rays and the claim form information. Indiana dentists formed the Indiana Federation of Dentists (IFD) in part to support the principle that a complete diagnosis is required for quality dentistry and that a complete diagnosis cannot be made on such a limited basis. The IFD asked its members not to cooperate in submitting x-rays to insurance carriers, and the FTC--in 1978--issued a complaint against the IFD on the basis that it restricted competition by its stand that no one should be permitted to diagnose who had not performed a complete diagnostic examination. The IFD stuck by its guns, and an FTC administrative law judge--in 1980--ordered dissolution of the IFD for boycott activities. The IFD continued the fight, and--in 1983--the FTC backed off the dissolution ruling but confirmed a boycott, and ordered the group to cease and desist refusing to submit x-rays to insurance carriers.
The IFD was not being intransigent--they were willing to discuss a diagnosis with a qualified representative of the insurance company in the dentist's office. That this might be impractical for insurance companies, they believed, ought not to validate a rule that was only for the convenience and financial advantage of insurance companies, and was not in the best interest of the public.
The IFD appealed the cease-and-desist order to the Seventh Circuit Court of Appeals, and the question was finally removed from the FTC bureaucracy and submitted to an impartial group of judges. In October 1984 the court overturned the FTC ruling, and concluded that the IFD was not anticompetitive. The court said that the IFD position "resulted from the dentists' adherence to a legal, moral, and ethical policy of quality dental care that requires a complete examination of all diagnostic aids before formulating a proper course of dental treatment".
The court added, "The commission's finding of a federal antitrust violation based upon the insufficient evidence presented in this case is a rubber-stamp approval of the group dental health care insurers' practice to formulate a course of dental treatment based solely upon dental x-rays and an insurance claim form, in violation of established, accepted, and approved standards of quality dental care". The court found that the FTC action was contrary to the consumer protection aspect of the antitrust laws, saying, "Indeed, by preventing dentists from joining together to promote standards of quality dental care that comport with the American Dental Association's code of professional conduct and the Indiana dental code, the commission, with absolutely no expertise or training in the highly advanced field of dentistry, unwisely regulates the dental profession and all of its specialties.... to the detriment of consumers. The group dental health care insurers cannot be permitted to forsake standards of quality and proper dental care in an attempt to lower their dental costs particularly in the instant case where there has been no finding that the review of dental x-rays alone actually reduces dental costs".
The Federal Trade Commission may well carry this case to the Supreme Court. The IFD, no doubt, will pursue the case on behalf of all of us, and the Supreme Court will have for its consideration the strong opinion of the first impartial judges who examined the evidence.
The success of the Indiana dentists in this instance is only one small step for mankind. It has to be weighed against all the successes the FTC has had by court action, legislative action, and sheer intimidation; and it is disheartening that the "sunset law" committees of Oregon and Virginia asked the FTC to review their state dental laws and regulations. The FTC predictably attacked rules against fee splitting, use of trade names, and various forms of advertising. The FTC doesn't like it if dentists are required to have their names on each office advertisement. It doesn't like a requirement to publish the original fee if you advertise a discount. It doesn't like restrictions on advertising quality or superiority. It doesn't like requirements of free choice of provider.
It is comforting to have a precedent on the books of one of the next-to-the-highest courts that so strongly supports the profession in its view of what is in the public's best interest. But the fight must go on to counter the FTC view that lower price is a consummate goal, and to fight its equation of dentistry with optometry.
All of dentistry ought to follow the example of the Indiana dentists--have some convictions about the delivery of dental care and have the courage of those convictions to pursue their advocacy with full commitment of time, money, and energy. There is only one guiding principle: what is in the best interest of the public? If we keep faith with that principle, we will confirm our calling, and we may prevent the FTC and other agencies with absolutely no expertise or training in the highly advanced field of dentistry from unwisely regulating the dental profession and all of its specialties to the detriment of consumers.
