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Interest of Amici Curiae) Tj /F15 11.97 Tf -1.68 -27.12 TD (Amici are professors at major universities who have researched and written extensively) Tj /F15 12.01 Tf 0.96 -27.36 TD (on health economics and the economics of industrial organization. i This submission describes) Tj /F15 12.00 Tf 0.00 -27.36 TD (what we believe are consensus views on some economic questions that arise in connection with) Tj /F15 11.97 Tf 0.00 -27.60 TD (with the August 6, 2007 ruling by the 鶹ý Trade Commission.) Tj /F14 11.95 Tf 0.00 -41.76 TD (2. Background) Tj /F15 12.00 Tf 0.00 -27.36 TD (The recent 5-0 ruling by the FTC Commissioners in the matter of Evanston Northwestern) Tj /F15 12.01 Tf -.24 -27.60 TD (Healthcare Corporation \(ENH\) Docket 9315 compromises a 23 year long effort by FTC) Tj /F15 11.99 Tf 0.24 -27.60 TD (economists and lawyers to limit provider market power and raises major issues about the future) Tj /F15 11.90 Tf 0.00 -27.60 TD (of competition in healthcare.) Tj /F15 11.99 Tf 0.00 -54.96 TD (The FTC has long sought to limit market power and promote competition in hospital markets.) Tj /F15 12.00 Tf 0.24 -27.60 TD (However, case after case failed in the past because in the view of the courts, FTC economists and) Tj /F15 12.08 Tf 0.00 -27.84 TD (lawyers were unable to satisfactorily demonstrate market power. In ENH, the FTC combined) Tj /F15 12.01 Tf -.24 -27.60 TD (rigorous new analysis of market power with strong empirical evidence to overcome past) Tj /F16 5.00 Tf 0.48 -27.84 TD (objections. In a seeming landmark decision, an administrative cour ) Tj /F15 12.09 Tf 329.52 0.72 TD (judge accepted the FTC's) Tj /F15 11.99 Tf -329.52 -28.08 TD (conclusion that concentration was excessive and ordered the hospitals to be split up.) Tj /F14 11.98 Tf 0.00 -41.28 TD (3. The Commissioners' ruling) Tj /F15 11.99 Tf 0.24 -27.12 TD (The Commissioners agreed with the judge's ruling that Evanston and Highland Park Hospitals) Tj /F15 12.17 Tf 0.00 -27.84 TD (had achieved excessive market power by forming ENH. But instead of affrming the judge's) Tj /F15 9.98 Tf 0.72 -52.08 TD (i A biographic sketch of each signatory is included in the Appendix.) 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Tj /F21 12.96 Tf 0.24 -41.52 TD (4. Why the Commissioners' ruling wil reduce competition and harm consumers) Tj /F21 12.00 Tf 0.00 -27.36 TD (In our view, the FTC Commissioners' decision effectively vitiates the judge's decision and) Tj /F23 5.00 Tf 0.24 -27.60 TD (substitutes a remedy which is likely to be ineffective in curbing anti ) Tj /F22 11.16 Tf 325.68 0.48 TD (competitive behavior for two) Tj /F21 11.50 Tf -325.92 -28.08 TD (reasons:) Tj /F21 12.18 Tf 17.76 -27.60 TD (A. Effective price competition is improbable. Given that both Evanston and Highland Park) Tj /F21 12.11 Tf 0.24 -27.36 TD (Hospitals report to the same ENH central office, there wil be ample, hard to oversee) Tj /F22 11.36 Tf 0.00 -27.60 TD (opportunities for collusion. The FTC could try to institute explicit oversight of pricing) Tj /F21 12.03 Tf 0.00 -29.76 TD (\(which is unlikely to be successful\), but this amounts to substituting regulation for) Tj /F23 5.00 Tf 0.00 -25.44 TD (competition, which is outside the FTC's legislated authority. But even if ) Tj /F21 11.97 Tf 357.12 0.96 TD (Evanston and) Tj /F21 12.00 Tf -357.12 -28.56 TD (Highland Park Hospitals do not directly or indirectly communicate about pricing, as long as) Tj /F23 5.00 Tf -.24 -27.60 TD (they act on behalf of ) Tj /F22 11.09 Tf 101.76 0.24 TD (the parent ENH, we can stil expect serious problems. Here is why.) Tj /F21 12.00 Tf -101.04 -27.84 TD (Suppose that one ENH hospital holds out for a high price and is excluded from a managed) Tj /F21 12.18 Tf -.24 -27.60 TD (care network, its patients wil just end up at the other ENH hospitaL. This wil encourage) Tj /F21 12.23 Tf 0.00 -27.60 TD (each to drive prices higher. In economics parlance, prices wil become "strategic) Tj /F21 12.10 Tf 0.00 -27.60 TD (complements." Systematic research and employer surveys show that when hospital prices) Tj /F21 12.00 Tf 0.48 -27.60 TD (increase, health insurers pass the costs along to enrollees, premiums increase, and some) Tj /F21 12.17 Tf 0.00 -27.36 TD (individuals and employers are priced out of the insurance market altogether. When hospital) Tj /F22 10.69 Tf -.24 -27.60 TD (prices increase, consumers and society overall shoulder the burden.) Tj /F21 12.10 Tf 0.24 -54.96 TD (B. The commissioners' ruling is an invitation to collude on quality, about which the decision) Tj /F21 12.09 Tf 0.24 -27.60 TD (says nothing. 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EXuki_z_7 %aK__&A}o=?5?o+=oY#r}߿۴믶oOխV׵ Jvn[kwWȏ߶o]7Z}I ‘RnJC 6cd#iH5i&qI SN&H'T CD PI1Apڠ=p ARxjwA jn&Vaa_l*’ Iᅑ" k V)RxDQ]j/+AGI,PզԶ c)Q endstream endobj 26 0 obj << /Length 2453 >> stream q q 612.00 0.00 0.00 792.00 0.00 0.00 cm /Im27 Do Q Q q BT 3 Tr /F28 12.08 Tf 87.60 708.00 TD (potential harm must not be overlooked. While quality competition may occur on general) Tj /F28 12.34 Tf 0.24 -27.60 TD (dimensions--.g. efforts to cut prescribing errors for medications, the literature suggests that) Tj 0.00 -27.60 TD (competition often centers on the availability of services. Under the baner of improving) Tj /F29 5.00 Tf 0.00 -27.60 TD (efficiency, what if ) Tj /F29 8.54 Tf 90.00 0.00 TD (Evanston and Highland Park decide to segment the market-say, let) Tj /F28 12.08 Tf -90.24 -27.36 TD (Evanston dominate in heart care and give cancer to Highland Park? This could easily create) Tj /F28 12.01 Tf 0.24 -27.36 TD (a "must have" situation for each hospital for some services, putting managed care plans in the) Tj /F29 5.00 Tf 0.00 -27.60 TD (situation of ) Tj /F30 11.27 Tf 56.40 0.00 TD (having to contract with both ifthey want to serve the North Shore market. The) Tj /F28 12.08 Tf -56.88 -27.84 TD (FTC could respond by trying to regulate strategic manipulation of service offerings. But this) Tj /F28 11.95 Tf 0.00 -27.60 TD (has the potential of making a bad situation worse.) Tj /F30 11.98 Tf -17.76 -41.52 TD (5. Summary) Tj /F28 5.00 Tf 0.00 -27.12 TD (If ) Tj /F28 12.01 Tf 10.32 0.00 TD (the United States is going to have a market-based healthcare system, it is critical to preserve) Tj /F28 12.07 Tf -10.32 -27.60 TD (competition in the marketplace. If the FTC takes its charge of protecting consumers and society) Tj /F28 12.00 Tf 0.00 -27.60 TD (in all markets, including heath care, seriously, then the Commissioners' ENH ruling is clearly a) Tj /F28 11.86 Tf 0.24 -27.60 TD (step in the wrong direction.) Tj /F28 11.87 Tf -.24 -55.44 TD (Dated: October 16, 2007) Tj /F28 11.93 Tf 216.00 -27.36 TD (Respectfully submitted,) Tj /F29 16.56 Tf 6.96 -20.64 TD (/rj -- eX\)) Tj /F29 17.34 Tf 4.56 -9.12 TD (k ~ . .' . . -) Tj /F30 15.45 Tf -12.00 -5.76 TD (\(/ ..!A..A '-... _' '-.i?"..--.) 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He has a Ph.D. in Economics from Stanford University. Professor) Tj /F42 12.00 Tf 0.24 -27.60 TD (Dranove's research focuses on problems in industrial organization and business strategy with an) Tj /F42 11.96 Tf -.24 -27.60 TD (emphasis on the health care industry.) Tj /F43 5.00 Tf 0.00 -27.60 TD (LeeIDore Dafny is Assistant Professor of ) Tj /F42 12.00 Tf 202.56 0.24 TD (Management and Strategy at Northwestern) Tj /F43 5.00 Tf -202.56 -27.84 TD (University's Kellogg Graduate School of ) Tj /F44 10.92 Tf 198.96 0.24 TD (Management. Her research focuses on competition in) Tj /F42 12.08 Tf -198.96 -27.60 TD (healthcare markets. She has a Ph.D. in economics from MIT.) Tj /F43 5.00 Tf 0.00 -27.60 TD (Roger Feldman is the Blue Cross Professor of ) Tj 229.20 0.48 TD (Health Insurance and Professor of ) Tj /F42 11.92 Tf 166.56 0.24 TD (Economics at) Tj /F43 5.00 Tf -396.00 -28.32 TD (the University of ) Tj /F42 12.16 Tf 84.00 0.24 TD (Minnesota. Dr. Feldman served on the Senior Staff ofthe President's Council) Tj /F42 12.08 Tf -83.52 -27.84 TD (of Economic Advisers during the Reagan Administration. He has advised Medicare on the) Tj /F42 12.00 Tf 0.00 -27.60 TD (design of a demonstration of competitive pricing for Medicare health plans and recently provided) Tj /F42 12.19 Tf 0.00 -27.60 TD (advice to the Assistant Secretary for Planing and Evaluation \(HHS\) on the potential of a) Tj /F42 12.12 Tf 0.00 -27.84 TD (national market for health savings accounts. He has been a consultant to the U.S. Department of) Tj /F42 12.00 Tf 0.00 -27.60 TD (Justice and several state regulatory agencies regarding health plan mergers and ownership) Tj /F42 11.55 Tf 0.24 -27.60 TD (changes.) Tj /F43 5.00 Tf -.24 -27.36 TD (Martin Gaynor is the E. J. Barone Professor of ) Tj /F44 11.22 Tf 234.00 0.48 TD (Economics and Health Policy at Caregie) Tj /F43 5.00 Tf -233.76 -28.08 TD (Mellon University's Heinz School of ) Tj /F44 10.95 Tf 181.44 0.24 TD (Public Policy and Management. Professor Gaynor's) Tj /F42 12.00 Tf -181.44 -27.84 TD (research focuses on competition in health care markets and on the role of incentive structures) Tj /F42 11.99 Tf 0.00 -27.60 TD (within health care. 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Tj /F49 12.04 Tf 0.00 -27.60 TD (Vivian Ho holds the James A. Baker III Institute Chair in Health Economics at Rice University.) Tj /F49 11.99 Tf 0.48 -27.60 TD (She is also an Associate Professor of Economics at Rice and an Associate Professor at the Baylor) Tj /F49 12.12 Tf -.24 -27.60 TD (College of Medicine. Ho has a PhD in Economics from Stanford University. Ho's research) Tj /F49 11.99 Tf 0.00 -27.60 TD (examines the effects of economic incentives and institutions on healthcare costs and outcomes,) Tj /F49 11.95 Tf -.48 -27.60 TD (with a focus on the hospital sector.) Tj /F49 12.20 Tf 0.24 -27.60 TD (Richard Lindrooth is an Associate Professor in Medical University of South Carolina's) Tj /F50 5.00 Tf -.24 -27.36 TD (Department of ) Tj 72.24 0.00 TD (Health Administration and Policy, where he is also Associate Director of ) Tj /F49 11.59 Tf 354.48 0.48 TD (the) Tj /F49 12.08 Tf -426.24 -28.08 TD (Center for Health Economic and Policy Studies. He has a Ph.D. in Economics from the) Tj /F50 5.00 Tf -.48 -27.60 TD (University of ) Tj /F49 12.06 Tf 66.48 0.24 TD (Washington. Professor Lindrooth's research is focused on the economics) Tj /F49 11.99 Tf -66.24 -28.08 TD (of the health care industry with an emphasis on the delivery hospital services.) Tj /F49 12.30 Tf -.24 -27.60 TD (Mark Satterthwaite is the A .C. Buehler Professor in Hospital and Health Services) Tj /F49 12.04 Tf 0.00 -27.60 TD (Management at Northwestern University's Kellogg School of Management. In addition, he is) Tj /F49 12.00 Tf 0.00 -27.36 TD (Professor of Managerial Economics, Professor of Strategy, and Director of the General Motors) Tj /F49 12.13 Tf 0.00 -27.60 TD (Research Center for Strategy in Management. He received his Ph.D. from the University of) Tj /F49 12.00 Tf 0.24 -27.60 TD (Wisconsin and is a fellow of both the Econometric Society and the American Academy of Arts) Tj /F49 12.08 Tf 0.00 -27.84 TD (and Sciences. 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Sibarium, Esq. )Tj 11.89 0 0 11.89 213.84 495.84 Tm (Charles B. Klein, Esq. )Tj 11.93 0 0 11.93 213.84 481.68 Tm (WINSTON & STRAWN, LLP )Tj 12.16 0 0 12.16 215.04 467.28 Tm (l700 K Street, NW )Tj 11.96 0 0 11.96 213.84 453.12 Tm (Washington, DC 20006-3817 )Tj EMC /P <>BDC 11.92 0 0 11.92 213.6 426.24 Tm (Duane M. Kelley, Esq. )Tj 11.93 0 0 11.93 213.84 412.08 Tm (WINSTON & STRAWN, LLP )Tj EMC /P <>BDC /T1_2 1 Tf 8.69 0 0 8.69 213.84 397.68 Tm (35 West W-acker Drive\001 )Tj EMC /P <>BDC /T1_0 1 Tf 11.86 0 0 11.86 213.84 383.52 Tm (Chicago, IL 60601-9703 )Tj EMC /P <>BDC 11.87 0 0 11.87 214.08 357.6 Tm (Steven M. Shapiro, Esq. )Tj 11.91 0 0 11.91 213.6 343.92 Tm (Jeffrey Sarles, Esq. )Tj 12 0 0 12 213.6 330 Tm (Mayer Brown Rowe and Maw )Tj 11.94 0 0 11.94 213.84 316.32 Tm (71 South Wacker Drive )Tj 11.93 0 0 11.93 213.84 302.4 Tm (Chicago, IL 60606 )Tj EMC /P <>BDC 11.91 0 0 11.91 216.48 275.04 Tm (Thomas H. Brock, Esq. )Tj EMC /P <>BDC /T1_2 1 Tf 9.08 0 0 9.08 216.72 261.12 Tm (Complaint Counsel\001 )Tj EMC /P <>BDC /T1_0 1 Tf 11.99 0 0 11.99 216.48 247.44 Tm (鶹ý Trade Commission )Tj 11.92 0 0 11.92 216.72 233.28 Tm (600 Pennsylvania Avenue, N.W. )Tj 11.96 0 0 11.96 213.6 219.12 Tm (Washington, D.C. 20580 )Tj EMC /P <>BDC 11.92 0 0 11.92 69.36 190.32 Tm (Dated: October 16, 2007 )Tj EMC /P <>BDC 28.25 0 0 28.25 366.72 181.68 Tm ('#\)~'d)Tj EMC /P <>BDC 39.88 0 0 39.88 368.64 172.8 Tm (" ,\) j)Tj EMC /P <>BDC 34.18 0 0 34.18 355.44 170.16 Tm (&a ,.,,~~, )Tj EMC /P <>BDC 11.93 0 0 11.93 357.84 148.8 Tm (David Dranove )Tj EMC ET endstream endobj 787 0 obj <>stream /Artifact <>BDC q 612 0 0 792 0 0 cm /Im0 Do Q EMC BT /P <>BDC /T1_0 1 Tf 3 Tr 12.1 0 0 12.1 69.6 707.76 Tm (and Yale University. Professor White's research focuses on the organizat\ ion and operation of )Tj EMC /P <>BDC /T1_1 1 Tf 10.41 0 0 10.41 69.36 680.16 Tm (healthcare markets. )Tj EMC ET endstream endobj 788 0 obj <>stream /Artifact <>BDC q 612 0 0 792 0 0 cm /Im0 Do Q EMC BT /P <>BDC /T1_0 1 Tf 3 Tr 12.09 0 0 12.09 69.6 707.76 Tm (Department of Justice, and the California Deparment of Corporations on a\ ntitrust issues.He\001 )Tj 11.97 0 0 11.97 69.36 680.4 Tm (received his Ph.D. in economics from Northwestern University.\001 )Tj 12.04 0 0 12.04 69.36 652.8 Tm (Vivian Ho holds the James A. Baker III Institute Chair in Health Economi\ cs at Rice University.\001 )Tj 11.99 0 0 11.99 69.84 625.2 Tm (She is also an Associate Professor of Economics at Rice and an Associate\ Professor at the Baylor\001 )Tj 12.12 0 0 12.12 69.6 597.6 Tm (College of Medicine. Ho has a PhD in Economics from Stanford University.\ Ho's research\001 )Tj 11.99 0 0 11.99 69.6 570 Tm (examines the effects of economic incentives and institutions on healthca\ re costs and outcomes,\001 )Tj 11.95 0 0 11.95 69.12 542.4 Tm (with a focus on the hospital sector.\001 )Tj 12.2 0 0 12.2 69.36 514.8 Tm (Richard Lindrooth is an Associate Professor in Medical University of Sou\ th Carolina's\001 )Tj EMC /P <>BDC /T1_1 1 Tf 5 0 0 5 69.12 487.44 Tm (Department of )Tj 14.448 0 Td (Health Administration and Policy, where he is also Associate Director of\ )Tj /T1_0 1 Tf 11.59 0 0 11.59 495.84 487.92 Tm (the )Tj EMC /P <>BDC 12.08 0 0 12.08 69.6 459.84 Tm (Center for Health Economic and Policy Studies. He has a Ph.D. in Economi\ cs from the )Tj EMC /P <>BDC 12.06 0 0 12.06 135.6 432.48 Tm (Washington. Professor Lindrooth's research is focused on the economics )Tj 11.99 0 0 11.99 69.36 404.4 Tm (of the health care industry with an emphasis on the delivery hospital se\ rvices. )Tj 12.3 0 0 12.3 69.12 376.8 Tm (Mark Satterthwaite is the A .C. Buehler Professor in Hospital and Health\ Services )Tj 12.04 0 0 12.04 69.12 349.2 Tm (Management at Northwestern University's Kellogg School of Management. In\ addition, he is )Tj 12 0 0 12 69.12 321.84 Tm (Professor of Managerial Economics, Professor of Strategy, and Director o\ f the General Motors )Tj 12.13 0 0 12.13 69.12 294.24 Tm (Research Center for Strategy in Management. He received his Ph.D. from t\ he University of )Tj 12 0 0 12 69.36 266.64 Tm (Wisconsin and is a fellow of both the Econometric Society and the Americ\ an Academy of Arts )Tj 12.08 0 0 12.08 69.36 238.8 Tm (and Sciences. A central theme of his research, which has been in both mi\ croeconomic theory )Tj 12.04 0 0 12.04 69.36 211.2 Tm (and health care economics, is how market paricipants' information affect\ s the prices that are )Tj 11.84 0 0 11.84 69.12 183.6 Tm (realized in the market. )Tj EMC /P <>BDC /T1_1 1 Tf 5 0 0 5 69.12 432.24 Tm (University of \001)Tj EMC /P <>BDC 0.048 -55.248 Td (Wiliam D. White is a Professor of )Tj 34.8 0 Td (Policy Analysis and Management and Director of )Tj /T1_2 1 Tf 10.56 0 0 10.56 484.8 156.24 Tm (the Sloan )Tj EMC /P <>BDC /T1_0 1 Tf 12.08 0 0 12.08 69.36 128.4 Tm (Program in Health Administration at Cornell University. He has a Ph.D. i\ n Economics from )Tj 12.16 0 0 12.16 69.36 100.8 Tm (Harvard University. Prior to coming to Cornell, he taught at the Univers\ ity of Ilinois in Chicago )Tj EMC ET endstream endobj 789 0 obj <>stream /Artifact <>BDC q 612 0 0 792 0 0 cm /Im0 Do Q EMC BT /P <>BDC /T1_0 1 Tf 3 Tr 12.6 0 0 12.6 286.08 708.24 Tm (Appendix )Tj EMC /P <>BDC /T1_1 1 Tf 11.17 0 0 11.17 400.32 681.12 Tm (Health Industry)Tj /T1_2 1 Tf 5 0 0 5 69.6 680.64 Tm (David Dranove is the Walter McNerney Distinguished Professor of )Tj EMC /P <>BDC /T1_0 1 Tf 11.96 0 0 11.96 414.24 653.76 Tm (Management, where he is )Tj 12 0 0 12 69.84 625.68 Tm (also Professor of Management and Strategy and Director of the Center for\ Health Industry )Tj 12.19 0 0 12.19 69.6 598.08 Tm (Market Economics. He has a Ph.D. in Economics from Stanford University. \ Professor )Tj 12 0 0 12 69.84 570.48 Tm (Dranove's research focuses on problems in industrial organization and bu\ siness strategy with an )Tj 11.96 0 0 11.96 69.6 542.88 Tm (emphasis on the health care industry. )Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 69.6 653.04 Tm (Management at Northwestern University's Kellogg Graduate School of \001)Tj EMC /P <>BDC /T1_0 1 Tf 12 0 0 12 272.16 515.52 Tm (Management and Strategy at Northwestern)Tj /T1_2 1 Tf 5 0 0 5 69.6 515.28 Tm (LeeIDore Dafny is Assistant Professor of )Tj EMC /P <>BDC /T1_1 1 Tf 10.92 0 0 10.92 268.56 487.92 Tm (Management. Her research focuses on competition in)Tj /T1_2 1 Tf 5 0 0 5 69.6 487.68 Tm (University's Kellogg Graduate School of )Tj EMC /P <>BDC /T1_0 1 Tf 12.08 0 0 12.08 69.6 460.32 Tm (healthcare markets. She has a Ph.D. in economics from MIT. )Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 69.6 432.72 Tm (Roger Feldman is the Blue Cross Professor of )Tj 45.84 0.096 Td (Health Insurance and Professor of )Tj /T1_0 1 Tf 11.92 0 0 11.92 465.36 433.44 Tm (Economics at )Tj EMC /P <>BDC 12.16 0 0 12.16 153.36 405.36 Tm (Minnesota. Dr. Feldman served on the Senior Staff ofthe President's Coun\ cil )Tj 12.08 0 0 12.08 69.84 377.52 Tm (of Economic Advisers during the Reagan Administration. He has advised Me\ dicare on the )Tj 12 0 0 12 69.84 349.92 Tm (design of a demonstration of competitive pricing for Medicare health pla\ ns and recently provided )Tj 12.19 0 0 12.19 69.84 322.32 Tm (advice to the Assistant Secretary for Planing and Evaluation \(HHS\) on \ the potential of a )Tj 12.12 0 0 12.12 69.84 294.48 Tm (national market for health savings accounts. He has been a consultant to\ the U.S. Department of )Tj 12 0 0 12 69.84 266.88 Tm (Justice and several state regulatory agencies regarding health plan merg\ ers and ownership )Tj 11.55 0 0 11.55 70.08 239.28 Tm (changes. )Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 69.36 405.12 Tm (the University of \001)Tj EMC /P <>BDC /T1_1 1 Tf 11.22 0 0 11.22 303.84 212.4 Tm (Economics and Health Policy at Caregie)Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 69.84 211.92 Tm (Martin Gaynor is the E. J. Barone Professor of \001)Tj EMC /P <>BDC /T1_1 1 Tf 10.95 0 0 10.95 251.52 184.56 Tm (Public Policy and Management. Professor Gaynor's)Tj /T1_2 1 Tf 5 0 0 5 70.08 184.32 Tm (Mellon University's Heinz School of )Tj /T1_0 1 Tf 12 0 0 12 70.08 156.72 Tm (research focuses on competition in health care markets and on the role o\ f incentive structures )Tj 11.99 0 0 11.99 70.08 129.12 Tm (within health care. He has served as a consultant to the 鶹ý Trade C\ ommission, U.S. )Tj EMC ET endstream endobj 790 0 obj <>stream /Artifact <>BDC q 612 0 0 792 0 0 cm /Im0 Do Q EMC BT /P <>BDC /T1_0 1 Tf 3 Tr 13.43 0 0 13.43 293.04 696 Tm (/J;Y/-; .~ \375! .\001)Tj EMC /P <>BDC /T1_1 1 Tf 29.06 0 0 29.06 286.8 692.64 Tm (.\337/tV. /' _J)Tj EMC /P <>BDC 16.83 0 0 16.83 372.72 687.12 Tm (~---)Tj EMC /P <>BDC 12.17 0 0 12.17 285.84 672 Tm (Marin Gaynor, Carnegie Mellon University )Tj EMC /P <>BDC 33.05 0 0 33.05 285.84 633.36 Tm (V~ 46 )Tj EMC /P <>BDC 11.98 0 0 11.98 285.84 620.88 Tm (Vivian Ho, Rice University )Tj EMC /P <>BDC 72 0 0 72 287.04 578.88 Tm (~ )Tj EMC /P <>BDC 11.99 0 0 11.99 285.84 566.16 Tm (Richard Lindrooth, Medical University of South )Tj 11.92 0 0 11.92 286.08 552.24 Tm (Carolina )Tj EMC /P <>BDC /T1_2 1 Tf 55.91 0 0 55.91 287.28 509.76 Tm (fkp\( ~)Tj EMC /P <>BDC /T1_1 1 Tf 11.98 0 0 11.98 285.84 491.28 Tm (Mark Satterthwaite, Northwestern University )Tj EMC /P <>BDC /T1_2 1 Tf 19.54 0 0 19.54 284.64 460.56 Tm (l\371 l.\350U \320. W\\.'H )Tj EMC /P <>BDC /T1_1 1 Tf 12.22 0 0 12.22 286.08 436.32 Tm (Willam D. White, Cornell University )Tj EMC ET endstream endobj 791 0 obj <>stream /Artifact <>BDC q 612 0 0 792 0 0 cm /Im0 Do Q EMC BT /P <>BDC /T1_0 1 Tf 3 Tr 12.08 0 0 12.08 87.6 708 Tm (potential harm must not be overlooked. While quality competition may occ\ ur on general )Tj EMC /P <>BDC 12.34 0 0 12.34 87.84 680.4 Tm (dimensions--.g. efforts to cut prescribing errors for medications, the l\ iterature suggests that )Tj 0 -2.237 TD (competition often centers on the availability of services. Under the ban\ er of improving )Tj EMC /P <>BDC /T1_1 1 Tf 5 0 0 5 87.84 625.2 Tm (efficiency, what if )Tj 8.54 0 0 8.54 177.84 625.2 Tm (Evanston and Highland Park decide to segment the market-say, let\001 )Tj EMC /P <>BDC /T1_0 1 Tf 12.08 0 0 12.08 87.6 597.84 Tm (Evanston dominate in heart care and give cancer to Highland Park? This c\ ould easily create )Tj 12.01 0 0 12.01 87.84 570.48 Tm (a "must have" situation for each hospital for some services, putting man\ aged care plans in the )Tj EMC /P <>BDC /T1_1 1 Tf 5 0 0 5 87.84 542.88 Tm (situation of \001)Tj EMC /P <>BDC /T1_2 1 Tf 11.27 0 0 11.27 144.24 542.88 Tm (having to contract with both ifthey want to serve the North Shore market\ . The )Tj EMC /P <>BDC /T1_0 1 Tf 12.08 0 0 12.08 87.36 515.04 Tm (FTC could respond by trying to regulate strategic manipulation of servic\ e offerings. But this )Tj 11.95 0 0 11.95 87.36 487.44 Tm (has the potential of making a bad situation worse. )Tj EMC /LI_Label <>BDC /T1_2 1 Tf 11.98 0 0 11.98 69.6 445.92 Tm (5.)Tj EMC /LI_Title <>BDC ( Summary )Tj EMC /P <>BDC /T1_0 1 Tf 5 0 0 5 69.6 418.8 Tm (If )Tj EMC /P <>BDC 12.01 0 0 12.01 79.92 418.8 Tm (the United States is going to have a market-based healthcare system, it \ is critical to preserve )Tj 12.07 0 0 12.07 69.6 391.2 Tm (competition in the marketplace. If the FTC takes its charge of protectin\ g consumers and society )Tj 12 0 0 12 69.6 363.6 Tm (in all markets, including heath care, seriously, then the Commissioners'\ ENH ruling is clearly a )Tj 11.86 0 0 11.86 69.84 336 Tm (step in the wrong direction. )Tj EMC /P <>BDC 11.87 0 0 11.87 69.6 280.56 Tm (Dated: October 16, 2007 )Tj 11.93 0 0 11.93 285.6 253.2 Tm (Respectfully submitted, )Tj EMC /P <>BDC /T1_1 1 Tf 16.56 0 0 16.56 292.56 232.56 Tm (/rj -- eX\)\001)Tj EMC /P <>BDC 17.34 0 0 17.34 297.12 223.44 Tm (k ~ . .' . . \255)Tj EMC /P <>BDC /T1_2 1 Tf 15.45 0 0 15.45 285.12 217.68 Tm (\(/ ..!\277A..A '-... _' '-.i?"..--. )Tj EMC /P <>BDC /T1_0 1 Tf 12.01 0 0 12.01 285.6 197.76 Tm (David Dranove, Northwestern University)Tj EMC /P <>BDC 72 0 0 72 286.56 164.16 Tm (~y~ )Tj EMC /P <>BDC 11.99 0 0 11.99 285.6 140.16 Tm (Leemore Dafny, Northwestern University )Tj EMC /P <>BDC /T1_2 1 Tf 37.59 0 0 37.59 286.08 103.92 Tm (\(l~ F~ )Tj EMC /P <>BDC /T1_1 1 Tf 5 0 0 5 285.6 76.32 Tm (Roger Feldman, University of )Tj /T1_0 1 Tf 12 0 0 12 432.72 76.56 Tm (Minnesota )Tj EMC ET endstream endobj 792 0 obj <>stream /Artifact <>BDC q 612 0 0 792 0 0 cm /Im0 Do Q EMC BT /P <>BDC /T1_0 1 Tf 3 Tr 12 0 0 12 69.6 706.8 Tm (order to force ENH to split up, the Commissioners ruled that ENH could r\ emain intact provided )Tj EMC /P <>BDC /T1_1 1 Tf 10.72 0 0 10.72 69.36 679.44 Tm (that the member hospitals set prices independently. )Tj EMC /LI_Label <>BDC /T1_0 1 Tf 12.96 0 0 12.96 69.6 637.92 Tm (4.)Tj EMC /LI_Title <>BDC ( Why the Commissioners' ruling wil reduce competition and harm consumers\ )Tj 12 0 0 12 69.6 610.56 Tm (In our view, the FTC Commissioners' decision effectively vitiates the ju\ dge's decision and )Tj EMC /P <>BDC /T1_1 1 Tf 11.16 0 0 11.16 395.52 583.44 Tm (competitive behavior for two)Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 69.84 582.96 Tm (substitutes a remedy which is likely to be ineffective in curbing anti \001\ )Tj EMC /P <>BDC /T1_0 1 Tf 11.5 0 0 11.5 69.6 555.36 Tm (reasons: )Tj EMC /LI_Label <>BDC 12.18 0 0 12.18 87.36 527.76 Tm (A.)Tj EMC /LI_Title <>BDC ( Effective price competition is improbable. Given that both Evanston and\ Highland Park )Tj 12.11 0 0 12.11 87.6 500.4 Tm (Hospitals report to the same ENH central office, there wil be ample, har\ d to oversee )Tj EMC /P <>BDC /T1_1 1 Tf 11.36 0 0 11.36 87.6 472.8 Tm (opportunities for collusion. The FTC could try to institute explicit ove\ rsight of pricing )Tj EMC /P <>BDC /T1_0 1 Tf 12.03 0 0 12.03 87.6 443.04 Tm (\(which is unlikely to be successful\), but this amounts to substituting\ regulation for )Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 87.6 417.6 Tm (competition, which is outside the FTC's legislated authority. But even i\ f )Tj /T1_0 1 Tf 11.97 0 0 11.97 444.72 418.56 Tm (Evanston and )Tj EMC /P <>BDC 12 0 0 12 87.6 390 Tm (Highland Park Hospitals do not directly or indirectly communicate about \ pricing, as long as )Tj EMC /P <>BDC /T1_1 1 Tf 11.09 0 0 11.09 189.12 362.64 Tm (the parent ENH, we can stil expect serious problems. Here is why.)Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 87.36 362.4 Tm (they act on behalf of \001)Tj EMC /P <>BDC /T1_0 1 Tf 12 0 0 12 88.08 334.8 Tm (Suppose that one ENH hospital holds out for a high price and is excluded\ from a managed )Tj 12.18 0 0 12.18 87.84 307.2 Tm (care network, its patients wil just end up at the other ENH hospitaL. Th\ is wil encourage )Tj 12.23 0 0 12.23 87.84 279.6 Tm (each to drive prices higher. In economics parlance, prices wil become "s\ trategic )Tj 12.1 0 0 12.1 87.84 252 Tm (complements." Systematic research and employer surveys show that when ho\ spital prices )Tj 12 0 0 12 88.32 224.4 Tm (increase, health insurers pass the costs along to enrollees, premiums in\ crease, and some )Tj 12.17 0 0 12.17 88.32 197.04 Tm (individuals and employers are priced out of the insurance market altoget\ her. When hospital )Tj EMC /P <>BDC /T1_1 1 Tf 10.69 0 0 10.69 88.08 169.44 Tm (prices increase, consumers and society overall shoulder the burden. )Tj EMC /LI_Label <>BDC /T1_0 1 Tf 12.1 0 0 12.1 88.32 114.48 Tm (B.)Tj EMC /LI_Title <>BDC ( The commissioners' ruling is an invitation to collude on quality, about\ which the decision )Tj 12.09 0 0 12.09 88.56 86.88 Tm (says nothing. Given the importance of quality for consumers of hospital \ services, the )Tj EMC ET endstream endobj 793 0 obj <>stream /Artifact <>BDC q 612 0 0 792 0 0 cm /Im0 Do Q EMC BT /LI_Label <>BDC /T1_0 1 Tf 3 Tr 11.83 0 0 11.83 70.56 680.88 Tm (1.)Tj EMC /LI_Title <>BDC ( Interest of Amici Curiae )Tj EMC /P <>BDC /T1_1 1 Tf 11.97 0 0 11.97 68.88 653.76 Tm (Amici are professors at major universities who have researched and writt\ en extensively )Tj 12.01 0 0 12.01 69.84 626.4 Tm (on health economics and the economics of industrial organization. i This\ submission describes )Tj 12 0 0 12 69.84 599.04 Tm (what we believe are consensus views on some economic questions that aris\ e in connection with )Tj 11.97 0 0 11.97 69.84 571.44 Tm (with the August 6, 2007 ruling by the 鶹ý Trade Commission. )Tj EMC /LI_Label <>BDC /T1_0 1 Tf 11.95 0 0 11.95 69.84 529.68 Tm (2.)Tj EMC /LI_Title <>BDC ( Background )Tj EMC /P <>BDC /T1_1 1 Tf 12 0 0 12 69.84 502.32 Tm (The recent 5-0 ruling by the FTC Commissioners in the matter of Evanston\ Northwestern )Tj 12.01 0 0 12.01 69.6 474.72 Tm (Healthcare Corporation \(ENH\) Docket 9315 compromises a 23 year long ef\ fort by FTC )Tj 11.99 0 0 11.99 69.84 447.12 Tm (economists and lawyers to limit provider market power and raises major i\ ssues about the future )Tj 11.9 0 0 11.9 69.84 419.52 Tm (of competition in healthcare. )Tj EMC /P <>BDC 11.99 0 0 11.99 69.84 364.56 Tm (The FTC has long sought to limit market power and promote competition in\ hospital markets. )Tj 12 0 0 12 70.08 336.96 Tm (However, case after case failed in the past because in the view of the c\ ourts, FTC economists and )Tj 12.08 0 0 12.08 70.08 309.12 Tm (lawyers were unable to satisfactorily demonstrate market power. In ENH, \ the FTC combined )Tj 12.01 0 0 12.01 69.84 281.52 Tm (rigorous new analysis of market power with strong empirical evidence to \ overcome past )Tj EMC /P <>BDC 12.09 0 0 12.09 399.84 254.4 Tm (judge accepted the FTC's )Tj 11.99 0 0 11.99 70.32 226.32 Tm (conclusion that concentration was excessive and ordered the hospitals to\ be split up. )Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 70.32 253.68 Tm (objections. In a seeming landmark decision, an administrative cour \001)Tj EMC /LI_Label <>BDC /T1_0 1 Tf 11.98 0 0 11.98 70.32 185.04 Tm (3.)Tj EMC /LI_Title <>BDC ( The Commissioners' ruling )Tj EMC /P <>BDC /T1_1 1 Tf 11.99 0 0 11.99 70.56 157.92 Tm (The Commissioners agreed with the judge's ruling that Evanston and Highl\ and Park Hospitals )Tj EMC /P <>BDC 12.17 0 0 12.17 70.56 130.08 Tm (had achieved excessive market power by forming ENH. But instead of affrm\ ing the judge's )Tj EMC /P <>BDC 9.98 0 0 9.98 71.28 78 Tm (i A biographic sketch of each signatory is included in the Appendix. )Tj EMC ET endstream endobj 794 0 obj <>stream /Artifact <>BDC q 612 0 0 792 0 0 cm /Im0 Do Q EMC BT /P <>BDC /T1_0 1 Tf 3 Tr 19.42 0 0 19.42 255.12 743.76 Tm (ORIGINAL\001 )Tj EMC /P <>BDC 12.61 0 0 12.61 214.56 708.48 Tm (UNITED STATES OF AMERICA )Tj EMC /P <>BDC /T1_1 1 Tf 12.27 0 0 12.27 183.12 687.6 Tm (BEFORE FEDERAL TRADE COMMISSION )Tj EMC /P <>BDC 12.01 0 0 12.01 69.36 653.28 Tm (COMMISSIONERS: Deborah Platt Majoras, Chairman )Tj EMC /P <>BDC /T1_0 1 Tf 13.18 0 0 13.18 179.52 639.6 Tm (Pamela Jones Harbour )Tj EMC /P <>BDC /T1_2 1 Tf 9.32 0 0 9.32 179.52 625.68 Tm (Jon Leibowitz\001 )Tj EMC /P <>BDC /T1_0 1 Tf 12.98 0 0 12.98 179.52 612 Tm (Wiliam E. Kovacic )Tj EMC /LI_Label <>BDC /T1_1 1 Tf 11.29 0 0 11.29 179.52 598.32 Tm (J.)Tj EMC /LI_Title <>BDC ( Thomas Rosch )Tj EMC /P <>BDC /T1_2 1 Tf 32.98 0 0 32.98 68.88 557.04 Tm (In the matter of I\001 )Tj EMC /P <>BDC /T1_0 1 Tf 5 0 0 5 424.08 541.2 Tm (I )Tj EMC /P <>BDC /T1_1 1 Tf -70.992 -2.304 Td (EVANSTON NORTHWESTERN HEALTHCARE CORPORATION )Tj EMC /P <>BDC 10.95 0 0 10.95 426.48 527.52 Tm (I Docket No. 9315 )Tj EMC /P <>BDC /T1_0 1 Tf 5 0 0 5 424.08 513.6 Tm (I )Tj EMC /P <>BDC 12.96 0 0 12.96 145.2 460.56 Tm (BRIEF AMICUS CURIE OF ECONOMICS PROFESSORS )Tj EMC /P <>BDC 12.75 0 0 12.75 197.28 419.04 Tm (David Dranove, Northwestern University )Tj 12.72 0 0 12.72 196.32 403.44 Tm (Leemore Dafny, Northwestern University )Tj 12.79 0 0 12.79 353.52 387.84 Tm (Minnesota)Tj EMC /P <>BDC /T1_2 1 Tf 5 0 0 5 198 387.6 Tm (Roger Feldman, University of \001)Tj EMC /P <>BDC 9.25 0 0 9.25 189.12 371.76 Tm (Martin Gaynor, Carnegie Mellon University\001 )Tj EMC /P <>BDC /T1_0 1 Tf 12.48 0 0 12.48 234.24 356.16 Tm (Vivian Ho, Rice University )Tj EMC /P <>BDC /T1_1 1 Tf 12.08 0 0 12.08 154.56 340.08 Tm (Richard Lindrooth, Medical University of South Carolina )Tj EMC /P <>BDC /T1_0 1 Tf 12.96 0 0 12.96 185.28 324.24 Tm (Mark Satterthwaite, Northwestern University\001 )Tj 12.95 0 0 12.95 214.32 308.4 Tm (Wiliam White, Cornell University\001 )Tj EMC /P <>BDC 12.11 0 0 12.11 322.08 262.56 Tm (\(PUBLIC\) )Tj EMC /P <>BDC 12.6 0 0 12.6 321.36 237.12 Tm (David Dranove )Tj 12.88 0 0 12.88 321.36 223.44 Tm (Department of Management and Strategy )Tj EMC /P <>BDC /T1_1 1 Tf 11.5 0 0 11.5 321.36 209.52 Tm (Kellogg School of Management )Tj 11.99 0 0 11.99 321.12 195.84 Tm (Northwestern University )Tj 11.33 0 0 11.33 321.36 181.92 Tm (2001 Sheridan Road )Tj EMC /P <>BDC /T1_2 1 Tf 9.22 0 0 9.22 321.36 168.24 Tm (Evanston, IL 60208\001 )Tj EMC /P <>BDC /T1_0 1 Tf 11.91 0 0 11.91 321.36 154.32 Tm (847-491-8682 )Tj EMC /P <>BDC /T1_2 1 Tf 9.49 0 0 9.49 69.36 126.72 Tm (October 16,2007\001 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