
CALIFORNIA
DENTAL ASSOCIATION, Petitioner,
v.
FEDERAL
TRADE COMMISSION.
No.
97-1625.
Supreme
Court of the United States
Argued
Jan. 13, 1999.
Decided
May 24, 1999.
Justice
SOUTER delivered the opinion of the Court.
There are
two issues in this case: whether the jurisdiction of the Federal Trade
Commission extends to the California Dental Association (CDA), a
nonprofit professional association, and whether a "quick look"
sufficed to justify finding that certain advertising restrictions
adopted by the CDA violated the antitrust laws. We hold that the
Commission's jurisdiction under the Federal Trade Commission Act (FTC
Act) extends to an association that, like the CDA, provides substantial
economic benefit to its for-profit members, but that where, as here, any
anticompetitive effects of given restraints are far from intuitively
obvious, the rule of reason demands a more thorough enquiry into the
consequences of those restraints than the Court of Appeals performed.
I.
The CDA
is a voluntary nonprofit association of local dental societies to which
some 19,000 dentists belong, including about three-quarters of those
practicing in the State. In re California Dental Assn., 121 F.T.C. 190,
196-197 (1996). The CDA is exempt from federal income tax under 26 U.S.C.
§ 501(c)(6), covering "[b]usiness leagues, chambers of commerce,
real-estate boards, [and] boards of trade," although it has for-
profit subsidiaries that give its members advantageous access to various
sorts of insurance, including liability coverage, and to financing for
their real estate, equipment, cars, and patients' bills. The CDA lobbies
and litigates in its members' interests, and conducts marketing and
public relations campaigns for their benefit. 128 F.3d 720, 723 (C.A.9
1997).
The
dentists who belong to the CDA through these associations agree to abide
by a Code of Ethics (Code) including the following § 10:
"Although
any dentist may advertise, no dentist shall advertise or solicit
patients in any form of communication in a manner that is false or
misleading in any material respect. In order to properly serve the
public, dentists should represent themselves in a manner that
contributes to the esteem of the public. Dentists should not
misrepresent their training and competence in any way that would be
false or misleading in any material respect." App. 33.
The CDA
has issued a number of advisory opinions interpreting this section,
[FN1] and through separate advertising guidelines intended to help
members comply with the Code and with state law the CDA has advised its
dentists of disclosures they must make under state law when engaging in
discount advertising. [FN2]
FN1.
The advisory opinions, which substantially mirror parts of the
California Business and Professions Code, see Cal. Bus. & Prof.Code
Ann. §§ 651, 1680 (West 1999), include the following propositions:
"A
statement or claim is false or misleading in any material respect when
it:
"a.
contains a misrepresentation of fact;
"b.
is likely to mislead or deceive because in context it makes only a
partial disclosure of relevant facts;
"c.
is intended or is likely to create false or unjustified expectations of
favorable results and/or costs;
"d.
relates to fees for specific types of services without fully and
specifically disclosing all variables and other relevant factors;
"e.
contains other representations or implications that in reasonable
probability will cause an ordinarily prudent person to misunderstand or
be deceived.
"Any
communication or advertisement which refers to the cost of dental
services shall be exact, without omissions, and shall make each service
clearly identifiable, without the use of such phrases as 'as low as,'
'and up,' 'lowest prices,' or words or phrases of similar import.
"Any
advertisement which refers to the cost of dental services and uses words
of comparison or relativity--for example, 'low fees'--must be based on
verifiable data substantiating the comparison or statement of
relativity. The burden shall be on the dentist who advertises in such
terms to establish the accuracy of the comparison or statement of
relativity."
"Advertising
claims as to the quality of services are not susceptible to measurement
or verification; accordingly, such claims are likely to be false or
misleading in any material respect." 128 F.3d 720, 723-724 (C.A.9
1997) (some internal quotation marks omitted).
FN2.
The disclosures include:
"1.
The dollar amount of the nondiscounted fee for the service[.]
"2.
Either the dollar amount of the discount fee or the percentage of the
discount for the specific service[.]
"3.
The length of time that the discount will be offered[.]
"4.
Verifiable fees[.]
"5.
[The identity of] [s]pecific groups who qualify for the discount or any
other terms and conditions or restrictions for qualifying for the
discount." Id., at 724.
Responsibility
for enforcing the Code rests in the first instance with the local dental
societies, to which applicants for CDA membership must submit copies of
their own advertisements and those of their employers or referral
services to assure compliance with the Code. The local societies also
actively seek information about potential Code violations by applicants
or CDA members. Applicants who refuse to withdraw or revise
objectionable advertisements may be denied membership; and members who,
after a hearing, remain similarly recalcitrant are subject to censure,
suspension, or expulsion from the CDA. 128 F.3d, at 724.
The
Commission brought a complaint against the CDA, alleging that it applied
its guidelines so as to restrict truthful, nondeceptive advertising, and
so violated § 5 of the FTC Act, 38 Stat. 717, 15 U.S.C. § 45. [FN3]
The complaint alleged that the CDA had unreasonably restricted two types
of advertising: price advertising, particularly discounted fees, and
advertising relating to the quality of dental services. Complaint ¶ 7.
An Administrative Law Judge (ALJ) held the Commission to have
jurisdiction over the CDA, which, the ALJ noted, had itself "stated
that a selection of its programs and services has a potential value to
members of between $22,739 and $65,127," 121 F.T.C., at 207. He
found that, although there had been no proof that the CDA exerted market
power, no such proof was required to establish an antitrust violation
under In re Mass. Bd. of Registration in Optometry, 110 F.T.C. 549
(1988), since the CDA had unreasonably prevented members and potential
members from using truthful, nondeceptive advertising, all to the
detriment of both dentists and consumers of dental services. He
accordingly found a violation of § 5 of the FTC Act. 121 F.T.C., at
272-273.
FN3.
The FTC Act's prohibition of unfair competition and deceptive acts or
practices, 15 U.S.C. § 45(a)(1), overlaps the scope of § 1 of the
Sherman Act, 15 U.S.C. § 1, aimed at prohibiting restraint of trade, FTC
v. Indiana Federation of Dentists, 476 U.S. 447, 454-455, 106 S.Ct.
2009, 90 L.Ed.2d 445 (1986), and the Commission relied upon Sherman Act
law in adjudicating this case, In re California Dental Assn., 121 F.T.C.
190, 292, n. 5 (1996).
The
Commission adopted the factual findings of the ALJ except for his
conclusion that the CDA lacked market power, with which the Commission
disagreed. The Commission treated the CDA's restrictions on discount
advertising as illegal per se. 128 F.3d, at 725. In the alternative, the
Commission held the price advertising (as well as the nonprice)
restrictions to be violations of the Sherman and FTC Acts under an
abbreviated rule-of-reason analysis. One Commissioner concurred
separately, arguing that the Commission should have applied the Mass Bd.
standard, not the per se analysis, to the limitations on price
advertising. Another Commissioner dissented, finding the evidence
insufficient to show either that the restrictions had an anticompetitive
effect under the rule of reason, or that the CDA had market power. 128
F.3d, at 725.
The Court
of Appeals for the Ninth Circuit affirmed, sustaining the Commission's
assertion of jurisdiction over the CDA and its ultimate conclusion on
the merits. Id., at 730. The court thought it error for the
Commission to have applied per se analysis to the price advertising
restrictions, finding analysis under the rule of reason required for all
the restrictions. But the Court of Appeals went on to explain that the
Commission had properly "applied an abbreviated, or 'quick look,'
rule of reason analysis designed for restraints that are not per se
unlawful but are sufficiently anticompetitive on their face that they do
not require a full-blown rule of reason inquiry. See [National
Collegiate Athletic Assn. v. Board of Regents of Univ. of Okla., 468
U.S. 85, 109-110, and n. 39, 104 S.Ct. 2948, 82 L.Ed.2d 70 (1984) ]
('The essential point is that the rule of reason can sometimes be
applied in the twinkling of an eye.') [Ibid. (citing P. Areeda,
The "Rule of Reason" in Antitrust Analysis: General Issues
37-38 (Federal Judicial Center, June 1981) (parenthetical omitted)).] It
allows the condemnation of a 'naked restraint' on price or output
without an 'elaborate industry analysis.' Id. at 109, 104 S.Ct.
2948." Id., at 727, 104 S.Ct. 2948.
The Court
of Appeals thought truncated rule-of-reason analysis to be in order for
several reasons. As for the restrictions on discount advertising, they
"amounted in practice to a fairly 'naked' restraint on price
competition itself," ibid. The CDA's procompetitive
justification, that the restrictions encouraged disclosure and prevented
false and misleading advertising, carried little weight because "it
is simply infeasible to disclose all of the information that is
required," id., at 728, and "the record provides no
evidence that the rule has in fact led to increased disclosure and
transparency of dental pricing," ibid. As to non-price
advertising restrictions, the court said that "[t]hese restrictions
are in effect a form of output limitation, as they restrict the supply
of information about individual dentists' services. See Areeda &
Hovenkamp, Antitrust Law ¶ 1505 at 693-694 (Supp.1997).... The
restrictions may also affect output more directly, as quality and
comfort advertising may induce some customers to obtain nonemergency
care when they might not otherwise do so.... Under these circumstances,
we think that the restriction is a sufficiently naked restraint on
output to justify quick look analysis." Ibid.
The Court
of Appeals went on to hold that the Commission's findings with respect
to the CDA's agreement and intent to restrain trade, as well as on the
effect of the restrictions and the existence of market power, were all
supported by substantial evidence. Id., at 728-730. In dissent,
Judge Real took the position that the Commission's jurisdiction did not
cover the CDA as a nonprofit professional association engaging in no
commercial operations. Id., at 730. But even assuming
jurisdiction, he argued, full-bore rule-of- reason analysis was called
for, since the disclosure requirements were not naked restraints and
neither fixed prices nor banned nondeceptive advertising. Id., at
730-731.
We
granted certiorari to resolve conflicts among the Circuits on the
Commission's jurisdiction over a nonprofit professional association
[FN4] and the occasions for abbreviated rule-of-reason analysis. [FN5]
524 U.S. ----, 119 S.Ct. 29, 141 L.Ed.2d 789 (1998). We now vacate the
judgment of the Court of Appeals and remand.
FN4.
Compare In re American Medical Assn., 94 F.T.C. 701, 983-984, aff'd, 638
F.2d 443 (C.A.2 1980), aff'd. by an equally divided Court, 455 U.S. 676,
102 S.Ct. 1744, 71 L.Ed.2d 546 (per curiam) (1982), FTC v. National
Comm'n on Egg Nutrition, 517 F.2d 485, 487-488 (C.A.7 1975), with Community
Blood Bank v. FTC, 405 F.2d 1011, 1017 (C.A.8 1969).
FN5.
Cf. Bogan v. Hodgkins, 166 F.3d 509, 514 & n. 6 (C.A.2 1999);
United States v. Brown University, 5 F.3d 658, 669 (C.A.3 1993); Chicago
Professional Sports Limited Partnership v. National Basketball Assn.,
961 F.2d 667, 674-676 (C.A.7 1992); Law v. National Collegiate
Athletic Assn., 134 F.3d 1010, 1020 (C.A.10 1998); U.S.
Healthcare, Inc. v. Healthsource, Inc., 986 F.2d 589, 594-595 (C.A.1
1993).
II.
The FTC
Act gives the Commission authority over "persons, partnerships, or
corporations," 15 U.S.C. § 45(a)(2), and defines
"corporation" to include "any company ... or association,
incorporated or unincorporated, without shares of capital or capital
stock or certificates of interest, except partnerships, which is
organized to carry on business for its own profit or that of its
members," § 44. Although the Circuits have not agreed on the
precise extent of this definition, see n. 4, supra, the
Commission has long held that some circumstances give it jurisdiction
over an entity that seeks no profit for itself. While the Commission has
claimed to have jurisdiction over a nonprofit entity if a substantial
part of its total activities provide pecuniary benefits to its members,
see In re American Medical Assn., 94 F.T.C. 701, 983-984 (1980),
respondent now advances the slightly different formulation that the
Commission has jurisdiction "over anticompetitive practices by
nonprofit associations whose activities provid[e] substantial economic
benefits to their for-profit members' businesses." Brief for
Respondent 20.
Respondent
urges deference to this interpretation of the Commission's jurisdiction
as reasonable. Brief for Respondent 25-26 (citing Chevron U.S.A. Inc.
v. Natural Resources Defense Council, Inc., 467 U.S. 837, 104 S.Ct.
2778, 81 L.Ed.2d 694 (1984), Mississippi Power & Light Co. v.
Mississippi ex rel. Moore, 487 U.S. 354, 380-382, 108 S.Ct. 2428,
101 L.Ed.2d 322 (1988) (SCALIA, J. concurring) (Chevron deference
applies to agency's interpretation of its own statutory jurisdiction)).
But we have no occasion to review the call for deference here, the
interpretation urged in respondent's brief being clearly the better
reading of the statute under ordinary principles of construction.
The FTC
Act is at pains to include not only an entity "organized to carry
on business for its own profit," 15 U.S.C. § 44, but also one that
carries on business for the profit "of its members," ibid.
While such a supportive organization may be devoted to helping its
members in ways beyond immediate enhancement of profit, no one here has
claimed that such an entity must devote itself single-mindedly to the
profit of others. It could, indeed, hardly be supposed that Congress
intended such a restricted notion of covered supporting organizations,
with the opportunity this would bring with it for avoiding jurisdiction
where the purposes of the FTC Act would obviously call for asserting it.
Just as
the FTC Act does not require that a supporting organization must devote
itself entirely to its members' profits, neither does the Act say
anything about how much of the entity's activities must go to raising
the members' bottom lines. There is accordingly no apparent reason to
let the statute's application turn on meeting some threshold percentage
of activity for this purpose, or even satisfying a softer formulation
calling for a substantial part of the nonprofit entity's total
activities to be aimed at its members' pecuniary benefit. To be sure,
proximate relation to lucre must appear; the FTC Act does not cover all
membership organizations of profit-making corporations without more, and
an organization devoted solely to professional education may lie outside
the FTC Act's jurisdictional reach, even though the quality of
professional services ultimately affects the profits of those who
deliver them.
There is
no line drawing exercise in this case, however, where the CDA's
contributions to the profits of its individual members are proximate and
apparent. Through for-profit subsidiaries, the CDA provides advantageous
insurance and preferential financing arrangements for its members, and
it engages in lobbying, litigation, marketing, and public relations for
the benefit of its members' interests. This congeries of activities
confers far more than de minimis or merely presumed economic benefits on
CDA members; the economic benefits conferred upon the CDA's
profit-seeking professionals plainly fall within the object of enhancing
its members' "profit," [FN6] which the FTC Act makes the
jurisdictional touchstone. There is no difficulty in concluding that the
Commission has jurisdiction over the CDA.
FN6.
This conclusion is consistent with holdings by a number of Courts of
Appeals. In FTC v. National Comm'n on Egg Nutrition, supra,
the Court of Appeals held that a nonprofit association "organized
for the profit of the egg industry," id., at 488, fell
within the Commission's jurisdiction. In American Medical Assn. v.
FTC, supra, the Court of Appeals held that the "business
aspects," id., at 448, of the AMA's activities brought it
within the Commission's reach. These cases are consistent with our
conclusion that an entity organized to carry on activities that will
confer greater than de minimis or presumed economic benefits on
profit-seeking members certainly falls within the Commission's
jurisdiction. In Community Blood Bank v. FTC, supra, the
Court of Appeals addressed the question whether the Commission had
jurisdiction over a blood bank and an association of hospitals. It held
that "the question of the jurisdiction over the corporations or
other associations involved should be determined on an ad hoc
basis," id., at 1018, and that the Commission's jurisdiction
extended to "any legal entity without shares of capital which
engages in business for profit within the traditional meaning of that
language," ibid. (emphasis deleted). The Court of Appeals
also said that "[a]ccording to a generally accepted definition
'profit' means gain from business or investment over and above
expenditures, or gain made on business or investment where both receipts
or payments are taken into account," id., at 1017, although
in the same breath it noted that the term's "meaning must be
derived from the context in which it is used," id., at 1016.
Our decision here is fully consistent with Community Blood Bank, because
the CDA contributes to the profits of at least some of its members, even
on a restrictive definition of profit as gain above expenditures. (It
should go without saying that the FTC Act does not require for
Commission jurisdiction that members of an entity turn a profit on their
membership, but only that the entity be organized to carry on business
for members' profit.) Nonetheless, we do not, and indeed, on the facts
here, could not, decide today whether the Commission has jurisdiction
over nonprofit organizations that do not confer profit on for-profit
members but do, for example, show annual income surpluses, engage in
significant commerce, or compete in relevant markets with for-profit
players. We therefore do not foreclose the possibility that various
paradigms of profit might fall within the ambit of the FTC Act. Nor do
we decide whether a purpose of contributing to profit only in a presumed
sense, as by enhancing professional educational efforts, would implicate
the Commission's jurisdiction.
The logic
and purpose of the FTC Act comport with this result. The FTC Act directs
the Commission to "prevent" the broad set of entities under
its jurisdiction "from using unfair methods of competition in or
affecting commerce and unfair or deceptive acts or practices in or
affecting commerce." 15 U.S.C. § 45(a)(2). Nonprofit entities
organized on behalf of for-profit members have the same capacity and
derivatively, at least, the same incentives as for-profit organizations
to engage in unfair methods of competition or unfair and deceptive acts.
It may even be possible that a nonprofit entity up to no good would have
certain advantages, not only over a for-profit member but over a
for-profit membership organization as well; it would enjoy the screen of
superficial disinterest while devoting itself to serving the interests
of its members without concern for doing more than breaking even.
Nor,
contrary to petitioner's argument, is the legislative history
inconsistent with this interpretation of the Commission's jurisdiction.
Although the versions of the FTC Act first passed by the House and the
Senate defined "corporation" to refer only to incorporated,
joint stock, and share- capital companies organized to carry on business
for profit, see H.R. Conf. Rep. No. 1142, 63d Cong., 2d Sess., 11, 14
(1914), the Conference Committee subsequently revised the definition to
its present form, an alteration that indicates an intention to include
nonprofit entities. [FN7] And the legislative history, like the text of
the FTC Act, is devoid of any hint at an exemption for professional
associations as such.
FN7.
A letter from Bureau of Corporations Commissioner Joseph E. Davies to
Senator Francis G. Newlands, the bill's sponsor and a member of the
Conference Committee, written August 8, 1914, before the Conference
Committee revisions, included a memorandum dated August 7, 1914, that
expressed concern that the versions of the bill passed by the House and
the Senate would not extend jurisdiction to purportedly nonprofit
organizations, which might "furnish convenient vehicles for common
understandings looking to the limitation of output and the fixing of
prices contrary to law." Trade Commission Bill: Letter from the
Commissioner of Corporations to the Chairman of the Senate Comm. on
Interstate Commerce, Transmitting Certain Suggestions Relative to the
Bill (H.R. 15613) to Create a Federal Trade Commission, 63d Cong., 2d
Sess., 3 (1914).
We
therefore conclude that the Commission had jurisdiction to pursue the
claim here, and turn to the question whether the Court of Appeals
devoted sufficient analysis to sustain the claim that the advertising
restrictions promulgated by the CDA violated the FTC Act.
III.
The Court
of Appeals treated as distinct questions the sufficiency of the analysis
of anticompetitive effects and the substantiality of the evidence
supporting the Commission's conclusions. Because we decide that the
Court of Appeals erred when it held as a matter of law that quick-look
analysis was appropriate (with the consequence that the Commission's
abbreviated analysis and conclusion were sustainable), we do not reach
the question of the substantiality of the evidence supporting the
Commission's conclusion. [FN8]
FN8.
We leave to the Court of Appeals the question whether on remand it can
effectively assess the Commission's decision for substantial evidence on
the record, or whether it must remand to the Commission for a more
extensive rule-of-reason analysis on the basis of an enhanced record.
In National
Collegiate Athletic Assn. v. Board of Regents of Univ. of Okla., 468
U.S. 85, 104 S.Ct. 2948, 82 L.Ed.2d 70 (1984), we held that a
"naked restraint on price and output requires some competitive
justification even in the absence of a detailed market analysis." Id.,
at 110, 104 S.Ct. 2948. Elsewhere, we held that "no elaborate
industry analysis is required to demonstrate the anticompetitive
character of " horizontal agreements among competitors to refuse to
discuss prices, National Soc. of Professional Engineers v. United
States, 435 U.S. 679, 692, 98 S.Ct. 1355, 55 L.Ed.2d 637 (1978), or
to withhold a particular desired service, FTC v. Indiana Federation
of Dentists, 476 U.S. 447, 459, 106 S.Ct. 2009, 90 L.Ed.2d 445
(1986) (quoting National Soc. of Professional Engineers, supra,
at 692, 98 S.Ct. 1355). In each of these cases, which have formed the
basis for what has come to be called abbreviated or
"quick-look" analysis under the rule of reason, an observer
with even a rudimentary understanding of economics could conclude that
the arrangements in question would have an anticompetitive effect on
customers and markets. In National Collegiate Athletic Assn., the
league's television plan expressly limited output (the number of games
that could be televised) and fixed a minimum price. 468 U.S., at 99-100,
104 S.Ct. 2948. In National Soc. of Professional Engineers, the
restraint was "an absolute ban on competitive bidding." 435
U.S., at 692, 98 S.Ct. 1355. In Indiana Federation of Dentists, the
restraint was "a horizontal agreement among the participating
dentists to withhold from their customers a particular service that they
desire." 476 U.S., at 459, 106 S.Ct. 2009. As in such cases,
quick-look analysis carries the day when the great likelihood of
anticompetitive effects can easily be ascertained. See Law v.
National Collegiate Athletic Assn., 134 F.3d 1010, 1020 (C.A.10
1998) (explaining that quick-look analysis applies "where a
practice has obvious anticompetitive effects"); Chicago
Professional Sports Limited Partnership v. National Basketball Assn.,
961 F.2d 667, 674-676 (C.A.7 1992) (finding quick-look analysis adequate
after assessing and rejecting logic of proffered procompetitive
justifications); cf. United States v. Brown University, 5 F.3d
658, 677-678 (C.A.3 1993) (finding full rule-of-reason analysis required
where universities sought to provide financial aid to needy students and
noting by way of contrast that the agreements in National Soc. of
Professional Engineers and Indiana Federation of Dentists "embodied
a strong economic self-interest of the parties to them").
The case
before us, however, fails to present a situation in which the likelihood
of anticompetitive effects is comparably obvious. Even on Justice
BREYER's view that bars on truthful and verifiable price and quality
advertising are prima facie anticompetitive, see post, at 1619-1620
(opinion concurring in part and dissenting in part), and place the
burden of procompetitive justification on those who agree to adopt them,
the very issue at the threshold of this case is whether professional
price and quality advertising is sufficiently verifiable in theory and
in fact to fall within such a general rule. Ultimately our disagreement
with Justice BREYER turns on our different responses to this issue.
Whereas he accepts, as the Ninth Circuit seems to have done, that the
restrictions here were like restrictions on advertisement of price and
quality generally, see, e.g., post, at 1620, 1621, 1622, it seems to us
that the CDA's advertising restrictions might plausibly be thought to
have a net procompetitive effect, or possibly no effect at all on
competition. The restrictions on both discount and nondiscount
advertising are, at least on their face, designed to avoid false or
deceptive advertising [FN9] in a market characterized by striking
disparities between the information available to the professional and
the patient. [FN10] Cf. Carr & Mathewson, The Economics of Law
Firms: A Study in the Legal Organization of the Firm, 33 J. Law &
Econ. 307, 309 (1990) (explaining that in a market for complex
professional services, "inherent asymmetry of knowledge about the
product" arises because "professionals supplying the good are
knowledgeable [whereas] consumers demanding the good are
uninformed"); Akerlof, The Market for 'Lemons': Quality Uncertainty
and the Market Mechanism, 84 Q.J. Econ. 488 (1970) (pointing out quality
problems in market characterized by asymmetrical information). In a
market for professional services, in which advertising is relatively
rare and the comparability of service packages not easily established,
the difficulty for customers or potential competitors to get and verify
information about the price and availability of services magnifies the
dangers to competition associated with misleading advertising. What is
more, the quality of professional services tends to resist either
calibration or monitoring by individual patients or clients, partly
because of the specialized knowledge required to evaluate the services,
and partly because of the difficulty in determining whether, and the
degree to which, an outcome is attributable to the quality of services
(like a poor job of tooth-filling) or to something else (like a very
tough walnut). See Leland, Quacks, Lemons, and Licensing: A
Theory of Minimum Quality Standards, 87 J. Pol. Econ. 1328, 1330 (1979);
1 B. Furrow, T. Greaney, S. Johnson, T. Jost, & R. Schwartz, Health
Law § 3-1, p. 86 (1995) (describing the common view that "the lay
public is incapable of adequately evaluating the quality of medical
services"). Patients' attachments to particular professionals, the
rationality of which is difficult to assess, complicate the picture even
further. Cf. Evans, Professionals and the Production Function: Can
Competition Policy Improve Efficiency in the Licensed Professions?, in
Occupational Licensure and Regulation 235-236 (S. Rottenberg ed.1980)
(describing long-term relationship between professional and client not
as "a series of spot contracts" but rather as "a
long-term agreement, often implicit, to deal with each other in a set of
future unspecified or incompletely specified circumstances according to
certain rules," and adding that "[i]t is not clear how or if
these [implicit contracts] can be reconciled with the promotion of
effective price competition in individual spot markets for particular
services"). The existence of such significant challenges to
informed decisionmaking by the customer for professional services
immediately suggests that advertising restrictions arguably protecting
patients from misleading or irrelevant advertising call for more than
cursory treatment as obviously comparable to classic horizontal
agreements to limit output or price competition.
FN9.
That false or misleading advertising has an anticompetitive effect, as
that term is customarily used, has been long established. Cf. FTC v.
Algoma Lumber Co., 291 U.S. 67, 79-80, 54 S.Ct. 315, 78 L.Ed. 655
(1934) (finding a false advertisement to be unfair competition).
FN10.
"The fact that a restraint operates upon a profession as
distinguished from a business is, of course, relevant in determining
whether that particular restraint violates the Sherman Act. It would be
unrealistic to view the practice of professions as interchangeable with
other business activities, and automatically to apply to the professions
antitrust concepts which originated in other areas. The public service
aspect, and other features of the professions, may require that a
particular practice, which could properly be viewed as a violation of
the Sherman Act in another context, be treated differently." Goldfarb
v. Virginia State Bar, 421 U.S. 773, 788-789, n. 17, 95 S.Ct. 2004,
44 L.Ed.2d 572 (1975).
The
explanation proffered by the Court of Appeals for the likely
anticompetitive effect of the CDA's restrictions on discount advertising
began with the unexceptionable statements that "price advertising
is fundamental to price competition," 128 F.3d, at 727, and that
"[r]estrictions on the ability to advertise prices normally make it
more difficult for consumers to find a lower price and for dentists to
compete on the basis of price," ibid. (citing Bates v.
State Bar of Ariz., 433 U.S. 350, 364, 97 S.Ct. 2691, 53 L.Ed.2d 810
(1977); Morales v. Trans World Airlines, Inc., 504 U.S. 374, 388,
112 S.Ct. 2031, 119 L.Ed.2d 157 (1992)). The court then acknowledged
that, according to the CDA, the restrictions nonetheless furthered the
"legitimate, indeed procompetitive, goal of preventing false and
misleading price advertising." 128 F.3d, at 728. The Court of
Appeals might, at this juncture, have recognized that the restrictions
at issue here are very far from a total ban on price or discount
advertising, and might have considered the possibility that the
particular restrictions on professional advertising could have different
effects from those "normally" found in the commercial world,
even to the point of promoting competition by reducing the occurrence of
unverifiable and misleading across-the-board discount advertising.
[FN11] Instead, the Court of Appeals confined itself to the brief
assertion that the "CDA's disclosure requirements appear to
prohibit across-the-board discounts because it is simply infeasible to
disclose all of the information that is required," ibid.,
followed by the observation that "the record provides no evidence
that the rule has in fact led to increased disclosure and transparency
of dental pricing," ibid.
FN11.
Justice BREYER claims that "the Court of Appeals did consider the
relevant differences." Post, at 1622. But the language he cites
says nothing more than that per se analysis is inappropriate here and
that "some caution" was appropriate where restrictions
purported to restrict false advertising, see 128 F.3d, at 726-727.
Caution was of course appropriate, but this statement by the Court of
Appeals does not constitute a consideration of the possible differences
between these and other advertising restrictions.
But these
observations brush over the professional context and describe no
anticompetitive effects. Assuming that the record in fact supports the
conclusion that the CDA disclosure rules essentially bar advertisement
of across-the-board discounts, it does not obviously follow that such a
ban would have a net anticompetitive effect here. Whether advertisements
that announced discounts for, say, first-time customers, would be less
effective at conveying information relevant to competition if they
listed the original and discounted prices for checkups, X-rays, and
fillings, than they would be if they simply specified a percentage
discount across the board, seems to us a question susceptible to
empirical but not a priori analysis. In a suspicious world, the
discipline of specific example may well be a necessary condition of
plausibility for professional claims that for all practical purposes
defy comparison shopping. It is also possible in principle that, even if
across- the-board discount advertisements were more effective in drawing
customers in the short run, the recurrence of some measure of
intentional or accidental misstatement due to the breadth of their
claims might leak out over time to make potential patients skeptical of
any such across-the-board advertising, so undercutting the method's
effectiveness. Cf. Akerlof, 84 Q.J. Econ., at 495 (explaining that
"dishonest dealings tend to drive honest dealings out of the
market"). It might be, too, that across-the-board discount
advertisements would continue to attract business indefinitely, but
might work precisely because they were misleading customers, and thus
just because their effect would be anticompetitive, not procompetitive.
Put another way, the CDA's rule appears to reflect the prediction that
any costs to competition associated with the elimination of
across-the-board advertising will be outweighed by gains to consumer
information (and hence competition) created by discount advertising that
is exact, accurate, and more easily verifiable (at least by regulators).
As a matter of economics this view may or may not be correct, but it is
not implausible, and neither a court nor the Commission may initially
dismiss it as presumptively wrong. [FN12]
FN12.
Justice BREYER suggests that our analysis is "of limited
relevance," post, at 1623, because "the basic question is
whether this ... theoretically redeeming virtue in fact offsets the
restrictions' anticompetitive effects in this case," ibid.
He thinks that the Commission and the Court of Appeals "adequately
answered that question," ibid., but the absence of any
empirical evidence on this point indicates that the question was not
answered, merely avoided by implicit burden- shifting of the kind
accepted by Justice BREYER. The point is that before a theoretical claim
of anticompetitive effects can justify shifting to a defendant the
burden to show empirical evidence of procompetitive effects, as
quick-look analysis in effect requires, there must be some indication
that the court making the decision has properly identified the
theoretical basis for the anticompetitive effects and considered whether
the effects actually are anticompetitive. Where, as here, the
circumstances of the restriction are somewhat complex, assumption alone
will not do.
In
theory, it is true, the Court of Appeals neither ruled out the
plausibility of some procompetitive support for the CDA's requirements
nor foreclosed the utility of an evidentiary discussion on the point.
The court indirectly acknowledged the plausibility of procompetitive
justifications for the CDA's position when it stated that "the
record provides no evidence that the rule has in fact led to increased
disclosure and transparency of dental pricing," 128 F.3d, at 728.
But because petitioner alone would have had the incentive to introduce
such evidence, the statement sounds as though the Court of Appeals may
have thought it was justified without further analysis to shift a burden
to the CDA to adduce hard evidence of the procompetitive nature of its
policy; the court's adversion to empirical evidence at the moment of
this implicit burden-shifting underscores the leniency of its enquiry
into evidence of the restrictions' anticompetitive effects.
The Court
of Appeals was comparably tolerant in accepting the sufficiency of
abbreviated rule-of-reason analysis as to the nonprice advertising
restrictions. The court began with the argument that "[t]hese
restrictions are in effect a form of output limitation, as they restrict
the supply of information about individual dentists' services." Ibid.
(citing P. Areeda & H. Hovenkamp, Antitrust Law ¶ 1505, pp. 693-694
(1997 Supp.)). Although this sentence does indeed appear as cited, it is
puzzling, given that the relevant output for antitrust purposes here is
presumably not information or advertising, but dental services
themselves. The question is not whether the universe of possible
advertisements has been limited (as assuredly it has), but whether the
limitation on advertisements obviously tends to limit the total delivery
of dental services. The court came closest to addressing this latter
question when it went on to assert that limiting advertisements
regarding quality and safety "prevents dentists from fully
describing the package of services they offer," 128 F.3d, at 728,
adding that "[t]he restrictions may also affect output more
directly, as quality and comfort advertising may induce some customers
to obtain nonemergency care when they might not otherwise do so," ibid.
This suggestion about output is also puzzling. If quality advertising
actually induces some patients to obtain more care than they would in
its absence, then restricting such advertising would reduce the demand
for dental services, not the supply; and it is of course the producers'
supply of a good in relation to demand that is normally relevant in
determining whether a producer-imposed output limitation has the
anticompetitive effect of artificially raising prices, [FN13] see General
Leaseways, Inc. v. National Truck Leasing Assn., 744 F.2d 588,
594-595 (C.A.7 1984) ("An agreement on output also equates to a
price-fixing agreement. If firms raise price, the market's demand for
their product will fall, so the amount supplied will fall too--in other
words, output will be restricted. If instead the firms restrict output
directly, price will as mentioned rise in order to limit demand to the
reduced supply. Thus, with exceptions not relevant here, raising price,
reducing output, and dividing markets have the same anticompetitive
effects").
FN13.
Justice BREYER wonders if we "mea[n] this statement as an argument
against the anticompetitive tendencies that flow from an agreement not
to advertise service quality." Post, at 1622. But as the preceding
sentence shows, we intend simply to question the logic of the Court of
Appeals's suggestion that the restrictions are anticompetitive because
they somehow "affect output," 128 F.3d, at 728, presumably
with the intent to raise prices by limiting supply while demand remains
constant. We do not mean to deny that an agreement not to advertise
service quality might have anticompetitive effects. We merely mean that,
absent further analysis of the kind Justice BREYER undertakes, it is not
possible to conclude that the net effect of this particular restriction
is anticompetitive.
Although
the Court of Appeals acknowledged the CDA's view that "claims about
quality are inherently unverifiable and therefore misleading," 128
F.3d, at 728, it responded that this concern "does not justify
banning all quality claims without regard to whether they are, in fact,
false or misleading," ibid. As a result, the court said,
"the restriction is a sufficiently naked restraint on output to
justify quick look analysis." Ibid. The court assumed, in
these words, that some dental quality claims may escape justifiable
censure, because they are both verifiable and true. But its implicit
assumption fails to explain why it gave no weight to the countervailing,
and at least equally plausible, suggestion that restricting
difficult-to-verify claims about quality or patient comfort would have a
procompetitive effect by preventing misleading or false claims that
distort the market. It is, indeed, entirely possible to understand the
CDA's restrictions on unverifiable quality and comfort advertising as
nothing more than a procompetitive ban on puffery, cf. Bates, 433 U.S.,
at 366, 97 S.Ct. 2691 (claims relating to the quality of legal services
"probably are not susceptible of precise measurement or
verification and, under some circumstances, might well be deceptive or
misleading to the public, or even false"); id., at 383-384,
97 S.Ct. 2691 ("[A]dvertising claims as to the quality of services
... are not susceptible of measurement or verification; accordingly,
such claims may be so likely to be misleading as to warrant
restriction"), notwithstanding Justice BREYER's citation (to a
Commission discussion that never faces the issue of the unverifiability
of professional quality claims, raised in Bates ), post, at 1620. [FN14]
FN14.
The Commission said only that " 'mere puffing' deceives no one and
has never been subject to regulation.' " 121 F.T.C., at 318. The
question here, of course, is not whether puffery may be subject to
governmental regulation, but whether a professional organization may ban
it.
The point
is not that the CDA's restrictions necessarily have the procompetitive
effect claimed by the CDA; it is possible that banning quality claims
might have no effect at all on competitiveness if, for example, many
dentists made very much the same sort of claims. And it is also of
course possible that the restrictions might in the final analysis be
anticompetitive. The point, rather, is that the plausibility of
competing claims about the effects of the professional advertising
restrictions rules out the indulgently abbreviated review to which the
Commission's order was treated. The obvious anticompetitive effect that
triggers abbreviated analysis has not been shown.
In light
of our focus on the adequacy of the Court of Appeals's analysis, Justice
BREYER's thorough-going, de novo antitrust analysis contains much to
impress on its own merits but little to demonstrate the sufficiency of
the Court of Appeals's review. The obligation to give a more deliberate
look than a quick one does not arise at the door of this Court and
should not be satisfied here in the first instance. Had the Court of
Appeals engaged in a painstaking discussion in a league with Justice
BREYER's (compare his 14 pages with the Ninth Circuit's 8), and had it
confronted the comparability of these restrictions to bars on clearly
verifiable advertising, its reasoning might have sufficed to justify its
conclusion. Certainly Justice BREYER's treatment of the antitrust issues
here is no "quick look." Lingering is more like it, and indeed
Justice BREYER, not surprisingly, stops short of endorsing the Court of
Appeals's discussion as adequate to the task at hand.
Saying
here that the Court of Appeals's conclusion at least required a more
extended examination of the possible factual underpinnings than it
received is not, of course, necessarily to call for the fullest market
analysis. Although we have said that a challenge to a "naked
restraint on price and output" need not be supported by "a
detailed market analysis" in order to "requir[e] some
competitive justification," National Collegiate Athletic Assn., 468
U.S., at 110, 104 S.Ct. 2948, it does not follow that every case
attacking a less obviously anticompetitive restraint (like this one) is
a candidate for plenary market examination. The truth is that our
categories of analysis of anticompetitive effect are less fixed than
terms like "per se," "quick look," and "rule of
reason" tend to make them appear. We have recognized, for example,
that "there is often no bright line separating per se from Rule of
Reason analysis," since "considerable inquiry into market
conditions" may be required before the application of any so-called
"per se " condemnation is justified. Id., at 104, n.
26, 104 S.Ct. 2948. "[W]hether the ultimate finding is the product
of a presumption or actual market analysis, the essential inquiry
remains the same--whether or not the challenged restraint enhances
competition." Id., at 104, 104 S.Ct. 2948. Indeed, the
scholar who enriched antitrust law with the metaphor of "the
twinkling of an eye" for the most condensed rule-of-reason analysis
himself cautioned against the risk of misleading even in speaking of a
'spectrum' of adequate reasonableness analysis for passing upon
antitrust claims: "There is always something of a sliding scale in
appraising reasonableness, but the sliding scale formula deceptively
suggests greater precision than we can hope for.... Nevertheless, the
quality of proof required should vary with the circumstances." P.
Areeda, Antitrust Law ¶ 1507, p. 402 (1986). [FN15] At the same time,
Professor Areeda also emphasized the necessity, particularly great in
the quasi-common law realm of antitrust, that courts explain the logic
of their conclusions. "By exposing their reasoning, judges ... are
subjected to others' critical analyses, which in turn can lead to better
understanding for the future." Id., ¶ 1500, at 364. As the
circumstances here demonstrate, there is generally no categorical line
to be drawn between restraints that give rise to an intuitively obvious
inference of anticompetitive effect and those that call for more
detailed treatment. What is required, rather, is an enquiry meet for the
case, looking to the circumstances, details, and logic of a restraint.
The object is to see whether the experience of the market has been so
clear, or necessarily will be, that a confident conclusion about the
principal tendency of a restriction will follow from a quick (or at
least quicker) look, in place of a more sedulous one. And of course what
we see may vary over time, if rule- of-reason analyses in case after
case reach identical conclusions. For now, at least, a less quick look
was required for the initial assessment of the tendency of these
professional advertising restrictions. Because the Court of Appeals did
not scrutinize the assumption of relative anticompetitive tendencies, we
vacate the judgment and remand the case for a fuller consideration of
the issue.
FN15.
Other commentators have expressed similar views. See, e.g.,
Kolasky, Counterpoint: The Department of Justice's "Stepwise"
Approach Imposes Too Heavy a Burden on Parties to Horizontal Agreements,
Antitrust 41, 43 (Spring 1998) ("[I]n applying the rule of reason,
the courts, as with any balancing test, use a sliding scale to determine
how much proof to require"); Piraino, Making Sense of the Rule of
Reason: A New Standard for Section 1 of the Sherman Act, 47 Vand. L.Rev.
1753, 1771 (1994) ( "[C]ourts will have to undertake varying
degrees of inquiry depending upon the type of restraint at issue. The
legality of certain restraints will be easy to determine because their
competitive effects are obvious. Other restrictions will require a more
detailed analysis because their competitive impact is more
ambiguous"). But see Klein, A "Stepwise" Approach for
Analyzing Horizontal Agreements Will Provide a Much Needed Structure for
Antitrust Review, Antitrust 41, 42 (Spring 1990) (examination of
procompetitive justifications "is by no means a full scrutiny of
the proffered efficiency justification. It is, rather, a hard look at
the justification to determine if it meets the defendant's burden of
coming forward with--but not establishing--a valid efficiency
justification").
It is so
ordered.
DISSENTING
OPINION
Justice BREYER, with whom Justice STEVENS, Justice KENNEDY, and Justice GINSBURG
join, concurring in part and dissenting in part.
I agree
with the Court that the Federal Trade Commission has jurisdiction over
petitioner, and I join Parts I and II of its opinion. I also agree that
in a "rule of reason" antitrust case "the quality of
proof required should vary with the circumstances," that "[w]hat
is required ... is an enquiry meet for the case," and that the
object is a "confident conclusion about the principal tendency of a
restriction." Ante, at 1617-1618 (internal quotation marks
omitted). But I do not agree that the Court has properly applied those
unobjectionable principles here. In my view, a traditional application
of the rule of reason to the facts as found by the Commission requires
affirming the Commission--just as the Court of Appeals did below.
I.
The
Commission's conclusion is lawful if its "factual findings,"
insofar as they are supported by "substantial evidence,"
"make out a violation of Sherman Act § 1." FTC v. Indiana
Federation of Dentists, 476 U.S. 447, 454-455, 106 S.Ct. 2009, 90
L.Ed.2d 445 (1986). To determine whether that is so, I would not simply
ask whether the restraints at issue are anticompetitive overall. Rather,
like the Court of Appeals (and the Commission), I would break that
question down into four classical, subsidiary antitrust questions: (1)
What is the specific restraint at issue? (2) What are its likely
anticompetitive effects? (3) Are there offsetting procompetitive
justifications? (4) Do the parties have sufficient market power to make
a difference?
A.
The most
important question is the first: What are the specific restraints at
issue? See, e.g., National Collegiate Athletic Assn. v. Board
of Regents of Univ. of Okla., 468 U.S. 85, 98-100, 104 S.Ct. 2948,
82 L.Ed.2d 70 (1984) (NCAA); Broadcast Music, Inc. v. Columbia
Broadcasting System, Inc., 441 U.S. 1, 21-23, 99 S.Ct. 1551, 60
L.Ed.2d 1 (1979). Those restraints do not include merely the agreement
to which the California Dental Association’s (Dental Association or
Association) ethical rule literally refers, namely, a promise to refrain
from advertising that is " ‘false or misleading in any material
respect.’ " Ante, at 1608 (quoting California Dental Code of
Ethics § 10 (1993), App. 33). Instead, the Commission found a set of
restraints arising out of the way the Dental Association implemented
this innocent-sounding ethical rule in practice, through advisory
opinions, guidelines, enforcement policies, and review of membership
applications. In re California Dental Assn., 121 F.T.C. 190 (1996). As
implemented, the ethical rule reached beyond its nominal target, to
prevent truthful and nondeceptive advertising. In particular, the
Commission determined that the rule, in practice:
1. "precluded
advertising that characterized a dentist’s fees as being low,
reasonable, or affordable," Id., at 301.
2. "precluded
advertising … of across the board discounts," ibid.; and
3. "prohibit[ed]
all quality claims," id., at 308.
Whether
the Dental Association’s basic rule as implemented actually restrained
the truthful and nondeceptive advertising of low prices,
across-the-board discounts, and quality service are questions of fact.
The Administrative Law Judge (ALJ) and the Commission may have found
those questions difficult ones. But both the ALJ and the Commission
ultimately found against the Dental Association in respect to these
facts. And the question for us—whether those agency findings are
supported by substantial evidence, see Indiana Federation, supra,
at 454-455, 106 S.Ct. 2009—is not difficult.
The Court
of Appeals referred explicitly to some of the evidence that it found
adequate to support the Commission’s conclusions. It pointed out, for
example, that the Dental Association’s "advisory opinions and
guidelines indicate that … descriptions of prices as ‘reasonable’
or ‘low’ do not comply" with the Association’s rule; that in
"numerous cases" the Association "advised members of
objections to special offers, senior citizen discounts, and new patient
discounts, apparently without regard to their truth"; and that one
advisory opinion "expressly states that claims as to the quality of
services are inherently likely to be false or misleading," all
"without any particular consideration of whether" such
statements were "true or false." 128 F.3d 720, 729 (C.A.9
1997).
The
Commission itself had before it far more evidence. It referred to
instances in which the Association, without regard for the truthfulness
of the statements at issue, recommended denial of membership to dentists
wishing to advertise, for example, "reasonable fees quoted in
advance," "major savings," or "making teeth cleaning
… inexpensive." 121 F.T.C., at 301. It referred to testimony that
"across-the-board discount advertising in literal compliance with
the requirements ‘would probably take two pages in the telephone book’
and ‘[n]obody is going to really advertise in that fashion.’ " Id.,
at 302. And it pointed to many instances in which the Dental Association
suppressed such advertising claims as "we guarantee all dental work
for 1 year," "latest in cosmetic dentistry," and
"gentle dentistry in a caring environment." Id., at
308-310.
I need
not review the evidence further, for this Court has said that
"substantial evidence" is a matter for the courts of appeals,
and that it "will intervene only in what ought to be the rare
instance when the standard appears to have been misapprehended or
grossly misapplied." Universal Camera Corp. v. NLRB, 340
U.S. 474, 490-491, 71 S.Ct. 456, 95 L.Ed. 456 (1951). I have said enough
to make clear that this is not a case warranting our intervention.
Consequently, we must decide only the basic legal question whether the
three restraints described above unreasonably restrict competition.
B.
Do each
of the three restrictions mentioned have "the potential for genuine
adverse effects on competition"? Indiana Federation, 476 U.S., at
460, 106 S.Ct. 2009; 7 P. Areeda, Antitrust Law ¶ 1503a, pp. 372-377
(1986) (hereinafter Areeda). I should have thought that the
anticompetitive tendencies of the three restrictions were obvious. An
agreement not to advertise that a fee is reasonable, that service is
inexpensive, or that a customer will receive a discount makes it more
difficult for a dentist to inform customers that he charges a lower
price. If the customer does not know about a lower price, he will find
it more difficult to buy lower price service. That fact, in turn, makes
it less likely that a dentist will obtain more customers by offering
lower prices. And that likelihood means that dentists will prove less
likely to offer lower prices. But why should I have to spell out the
obvious? To restrain truthful advertising about lower prices is likely
to restrict competition in respect to price—"the central nervous
system of the economy." United States v. Socony-Vacuum Oil Co.,
310 U.S. 150, 226, n. 59, 60 S.Ct. 811, 84 L.Ed. 1129 (1940); cf., e.g.,
Bates v. State Bar of Ariz., 433 U.S. 350, 364, 97 S.Ct. 2691, 53
L.Ed.2d 810 (1977) (price advertising plays an "indispensable role
in the allocation of resources in a free enterprise system"); Virginia
Bd. of Pharmacy v. Virginia Citizens Consumer Council, Inc., 425
U.S. 748, 765, 96 S.Ct. 1817, 48 L.Ed.2d 346 (1976). The Commission
thought this fact sufficient to hold (in the alternative) that the price
advertising restrictions were unlawful per se. See 121 F.T.C., at
307; cf. Socony-Vacuum, supra, at 222-228, 60 S.Ct. 811 (finding
agreement among competitors to buy "spot-market oil" unlawful
per se because of its tendency to restrict price competition). For
present purposes, I need not decide whether the Commission was right in
applying a per se rule. I need only assume a rule of reason applies, and
note the serious anticompetitive tendencies of the price advertising
restraints.
The
restrictions on the advertising of service quality also have serious
anticompetitive tendencies. This is not a case of "mere
puffing," as the FTC recognized. See 121 F.T.C., at 317-318;
cf. ante, at 1616. The days of my youth, when the billboards near
Emeryville, California, home of AAA baseball’s Oakland Oaks, displayed
the name of "Painless" Parker, Dentist, are long gone—along
with the Oakland Oaks. But some parents may still want to know that a
particular dentist makes a point of "gentle care." Others may
want to know about 1-year dental work guarantees. To restrict that kind
of service quality advertisement is to restrict competition over the
quality of service itself, for, unless consumers know, they may not
purchase, and dentists may not compete to supply that which will make
little difference to the demand for their services. That, at any rate,
is the theory of the Sherman Act. And it is rather late in the day for
anyone to deny the significant anticompetitive tendencies of an
agreement that restricts competition in any legitimate respect, see,
e.g., Paramount Famous Lasky Corp. v. United States, 282 U.S. 30,
43, 51 S.Ct. 42, 75 L.Ed. 145 (1930); United States v. First Nat.
Pictures, Inc., 282 U.S. 44, 54-55, 51 S.Ct. 45, 75 L.Ed. 151
(1930), let alone one that inhibits customers from learning about the
quality of a dentist’s service.
Nor did
the Commission rely solely on the unobjectionable proposition that a
restriction on the ability of dentists to advertise on quality is likely
to limit their incentive to compete on quality. Rather, the Commission
pointed to record evidence affirmatively establishing that quality-based
competition is important to dental consumers in California. 121 F.T.C.,
at 309-311. Unsurprisingly, these consumers choose dental services based
at least in part on "information about the type and quality of
service." Id., at 249. Similarly, as the Commission noted,
the ALJ credited testimony to the effect that "advertising the
comfort of services will ‘absolutely’ bring in more patients,"
and, conversely, that restraining the ability to advertise based on
quality would decrease the number of patients that a dentist could
attract. Id., at 310. Finally, the Commission looked to the
testimony of dentists who themselves had suffered adverse effects on
their business when forced by petitioner to discontinue advertising
quality of care. See id., at 310-311.
The FTC
found that the price advertising restrictions amounted to a "naked
attempt to eliminate price competition." Id., at 300. It
found that the service quality advertising restrictions "deprive
consumers of information they value and of healthy competition for their
patronage." Id., at 311. It added that the
"anticompetitive nature of these restrictions" was
"plain." Ibid. The Court of Appeals agreed. I do not
believe it possible to deny the anticompetitive tendencies I have
mentioned.
C.
We must
also ask whether, despite their anticompetitive tendencies, these
restrictions might be justified by other procompetitive tendencies or
redeeming virtues. See 7 Areeda, ¶ 1504, at 377-383. This is a
closer question—at least in theory. The Dental Association argues that
the three relevant restrictions are inextricably tied to a legitimate
Association effort to restrict false or misleading advertising. The
Association, the argument goes, had to prevent dentists from engaging in
the kind of truthful, nondeceptive advertising that it banned in order
effectively to stop dentists from making unverifiable claims about price
or service quality, which claims would mislead the consumer.
The
problem with this or any similar argument is an empirical one.
Notwithstanding its theoretical plausibility, the record does not bear
out such a claim. The Commission, which is expert in the area of false
and misleading advertising, was uncertain whether petitioner had even
made the claim. It characterized petitioner’s efficiencies argument as
rooted in the (unproved) factual assertion that its ethical rule
"challenges only advertising that is false or misleading." 121
F.T.C., at 316 (emphasis added). Regardless, the Court of Appeals wrote,
in respect to the price restrictions, that "the record provides no
evidence that the rule has in fact led to increased disclosure and
transparency of dental pricing." 128 F.3d, at 728. With respect to
quality advertising, the Commission stressed that the Association
"offered no convincing argument, let alone evidence, that consumers
of dental services have been, or are likely to be, harmed by the broad
categories of advertising it restricts." 121 F.T.C., at 319. Nor
did the Court of Appeals think that the Association’s unsubstantiated
contention that "claims about quality are inherently unverifiable
and therefore misleading" could "justify banning all quality
claims without regard to whether they are, in fact, false or
misleading." 128 F.3d, at 728.
With one
exception, my own review of the record reveals no significant
evidentiary support for the proposition that the Association’s members
must agree to ban truthful price and quality advertising in order to
stop untruthful claims. The one exception is the obvious fact that one
can stop untruthful advertising if one prohibits all advertising. But
since the Association made virtually no effort to sift the false from
the true, see 121 F.T.C., at 316- 317, that fact does not make out a
valid antitrust defense. See NCAA, 468 U.S., at 119, 104 S.Ct.
2948; 7 Areeda, ¶ 1505, at 383-384.
In the
usual Sherman Act § 1 case, the defendant bears the burden of
establishing a procompetitive justification. See National Soc.
of Professional Engineers v. United States, 435 U.S. 679, 695, 98
S.Ct. 1355, 55 L.Ed.2d 637 (1978); 7 Areeda, ¶ 1507b, at 397; 11 H.
Hovenkamp, Antitrust Law ¶ 1914c, pp. 313-315 (1998); see also Law
v. National Collegiate Athletic Assn., 134 F.3d 1010, 1019 (C.A.10),
cert. denied, 525 U.S. ----, 119 S.Ct. 65, 142 L.Ed.2d 51 (1998); United
States v. Brown Univ., 5 F.3d 658, 669 (C.A.3 1993); Capital
Imaging Associates v. Mohawk Valley Medical Associates, Inc., 996
F.2d 537, 543 (C.A.2), cert. denied, 510 U.S. 947, 114 S.Ct. 388, 126
L.Ed.2d 337 (1993); Kreuzer v. American Academy of Periodontology,
735 F.2d 1479, 1492-1495 (C.A.D.C.1984). And the Court of Appeals was
correct when it concluded that no such justification had been
established here.
D.
I shall
assume that the Commission must prove one additional circumstance,
namely, that the Association’s restraints would likely have made a
real difference in the marketplace. See 7 Areeda, ¶ 1503, at
376-377. The Commission, disagreeing with the ALJ on this single point,
found that the Association did possess enough market power to make a
difference. In at least one region of California, the mid-Peninsula, its
members accounted for more than 90% of the marketplace; on average they
accounted for 75%. See 121 F.T.C., at 314. In addition, entry by
new dentists into the market place is fairly difficult. Dental education
is expensive (leaving graduates of dental school with $50,000-$100,000
of debt), as is opening a new dentistry office (which costs
$75,000-$100,000). Id., at 315-316. And Dental Association
members believe membership in the Association is important, valuable,
and recognized as such by the public. Id., at 312-313, 315-316.
These
facts, in the Court of Appeals’ view, were sufficient to show
"enough market power to harm competition through [the Association’s]
standard setting in the area of advertising." 128 F.3d, at 730. And
that conclusion is correct. Restrictions on advertising price discounts
in Palo Alto may make a difference because potential patients may not
respond readily to discount advertising by the handful (10%) of dentists
who are not members of the Association. And that fact, in turn, means
that the remaining 90% will prove less likely to engage in price
competition. Facts such as these have previously led this Court to find
market power—unless the defendant has overcome the showing with strong
contrary evidence. See, e.g., Indiana Federation, 476 U.S., at
456-457, 106 S.Ct. 2009; cf. United States v. Loew’s Inc., 371
U.S. 38, 45, 83 S.Ct. 97, 9 L.Ed.2d 11 (1962); Brown Shoe Co. v.
United States, 370 U.S. 294, 341-344, 82 S.Ct. 1502, 8 L.Ed.2d 510
(1962); accord, United States v. Aluminum Co. of America, 148
F.2d 416, 424 (C.A.2 1945). I can find no reason for departing from that
precedent here.
II.
In the
Court's view, the legal analysis conducted by the Court of Appeals was
insufficient, and the Court remands the case for a more thorough
application of the rule of reason. But in what way did the Court of
Appeals fail? I find the Court's answers to this question
unsatisfactory--when one divides the overall Sherman Act question into
its traditional component parts and adheres to traditional judicial
practice for allocating the burdens of persuasion in an antitrust case.
Did the
Court of Appeals misconceive the anticompetitive tendencies of the
restrictions? After all, the object of the rule of reason is to separate
those restraints that "may suppress or even destroy
competition" from those that "merely regulat[e] and perhaps
thereby promot[e] competition." Board of Trade of Chicago v.
United States, 246 U.S. 231, 238, 38 S.Ct. 242, 62 L.Ed. 683 (1918).
The majority says that the Association's "advertising restrictions
might plausibly be thought to have a net procompetitive effect, or
possibly no effect at all on competition." Ante, at 1613. It adds
that "advertising restrictions arguably protecting patients from
misleading or irrelevant advertising call for more than cursory
treatment as obviously comparable to classic horizontal agreements to
limit output or price competition." Ante, at 1614.
And it
criticizes the Court of Appeals for failing to recognize that "the
restrictions at issue here are very far from a total ban on price or
discount advertising" and that "the particular restrictions on
professional advertising could have different effects from those
'normally' found in the commercial world, even to the point of promoting
competition...." Ante, at 1614.
The
problem with these statements is that the Court of Appeals did consider
the relevant differences. It rejected the legal "treatment"
customarily applied "to classic horizontal agreements to limit
output or price competition"--i.e., the FTC's (alternative) per se
approach. See 128 F.3d, at 726-727. It did so because the
Association's "policies do not, on their face, ban truthful
nondeceptive ads"; instead, they "have been enforced in a way
that restricts truthful advertising." Id., at 727. It added
that "[t]he value of restricting false advertising ... counsels
some caution in attacking rules that purport to do so but merely sweep
too broadly." Ibid.
Did the
Court of Appeals misunderstand the nature of an anticompetitive effect?
The Court says:
"If
quality advertising actually induces some patients to obtain more care
than they would in its absence, then restricting such advertising would
reduce the demand for dental services, not the supply; and ... the
producers' supply ... is normally relevant in determining whether a ...
limitation has the anticompetitive effect of artificially raising
prices." Ante, at 1616.
But if
the Court means this statement as an argument against the
anticompetitive tendencies that flow from an agreement not to advertise
service quality, I believe it is the majority, and not the Court of
Appeals, that is mistaken. An agreement not to advertise, say,
"gentle care" is anticompetitive because it imposes an
artificial barrier against each dentist's independent decision to
advertise gentle care. That barrier, in turn, tends to inhibit those
dentists who want to supply gentle care from getting together with those
customers who want to buy gentle care. See P. Areeda & H.
Hovenkamp, Antitrust Law ¶ 1505', p. 404 (Supp.1998). There is adequate
reason to believe that tendency present in this case. See supra,
at 1620.
Did the
Court of Appeals inadequately consider possible procompetitive
justifications? The Court seems to think so, for it says:
"[T]he
[Association's] rule appears to reflect the prediction that any costs to
competition associated with the elimination of across-the-board
advertising will be outweighed by gains to consumer information (and
hence competition) created by discount advertising that is exact,
accurate, and more easily verifiable (at least by regulators)."
Ante, at 1615. That may or may not be an accurate assessment of the
Association's motives in adopting its rule, but it is of limited
relevance. Cf. Chicago Board of Trade, supra, at 238. The basic
question is whether this, or some other, theoretically redeeming virtue
in fact offsets the restrictions' anticompetitive effects in this case.
Both court and Commission adequately answered that question.
The
Commission found that the defendant did not make the necessary showing
that a redeeming virtue existed in practice. See 121 F.T.C., at
319-320. The Court of Appeals, asking whether the rules, as enforced,
"augment[ed] competition and increase[d] market efficiency,"
found the Commission's conclusion supported by substantial evidence. 128
F.3d, at 728. That is why the court said that "the record provides
no evidence that the rule has in fact led to increased disclosure and
transparency of dental pricing"--which is to say that the record
provides no evidence that the effects, though anticompetitive, are
nonetheless redeemed or justified. Ibid.
The
majority correctly points out that "petitioner alone would have had
the incentive to introduce such evidence" of procompetitive
justification. Ante, at 1615. (Indeed, that is one of the reasons
defendants normally bear the burden of persuasion about redeeming
virtues. See supra, at 1621.) But despite this incentive,
petitioner's brief in this Court offers nothing concrete to counter the
Commission's conclusion that the record does not support the claim of
justification. Petitioner's failure to produce such evidence itself
"explain[s] why [the lower court] gave no weight to the ...
suggestion that restricting difficult-to-verify claims about quality or
patient comfort would have a procompetitive effect by preventing
misleading or false claims that distort the market." Ante, at 1616.
With
respect to the restraint on advertising across-the-board discounts, the
majority summarizes its concerns as follows: "Assuming that the
record in fact supports the conclusion that the [Association's]
disclosure rules essentially bar advertisement of [such] discounts, it
does not obviously follow that such a ban would have a net
anticompetitive effect here." Ante, at 1614. I accept, rather than
assume, the premise: The FTC found that the disclosure rules did bar
advertisement of across-the-board discounts, and that finding is
supported by substantial evidence. See supra, at 1619. And
I accept as literally true the conclusion that the Court says follows
from that premise, namely, that "net anticompetitive effects"
do not "obviously " follow from that premise. But obviousness
is not the point. With respect to any of the three restraints found by
the Commission, whether "net anticompetitive effects" follow
is a matter of how the Commission, and, here, the Court of Appeals, have
answered the questions I laid out at the beginning. See supra,
at 1618-1619. Has the Commission shown that the restriction has
anticompetitive tendencies? It has. Has the Association nonetheless
shown offsetting virtues? It has not. Has the Commission shown market
power sufficient for it to believe that the restrictions will likely
make a real world difference? It has.
The
upshot, in my view, is that the Court of Appeals, applying ordinary
antitrust principles, reached an unexceptional conclusion. It is the
same legal conclusion that this Court itself reached in Indiana
Federation--a much closer case than this one. There the Court found that
an agreement by dentists not to submit dental X rays to insurers
violated the rule of reason. The anticompetitive tendency of that
agreement was to reduce competition among dentists in respect to their
willingness to submit X rays to insurers, see 476 U.S., at 456, 106 S.Ct.
2009--a matter in respect to which consumers are relatively indifferent,
as compared to advertising of price discounts and service quality, the
matters at issue here. The redeeming virtue in Indiana Federation was
the alleged undesirability of having insurers consider a range of
matters when deciding whether treatment was justified--a virtue no less
plausible, and no less proved, than the virtue offered here. See id.,
at 462-464, 106 S.Ct. 2009. The "power" of the dentists to
enforce their agreement was no greater than that at issue here (control
of 75% to 90% of the relevant markets). See id., at 460,
106 S.Ct. 2009. It is difficult to see how the two cases can be
reconciled.
I would
note that the form of analysis I have followed is not rigid; it admits
of some variation according to the circumstances. The important point,
however, is that its allocation of the burdens of persuasion reflects a
gradual evolution within the courts over a period of many years. That
evolution represents an effort carefully to blend the procompetitive
objectives of the law of antitrust with administrative necessity. It
represents a considerable advance, both from the days when the
Commission had to present and/or refute every possible fact and theory,
and from antitrust theories so abbreviated as to prevent proper
analysis. The former prevented cases from ever reaching a conclusion,
cf. Bok, Section 7 of the Clayton Act and the Merging of Law and
Economics, 74 Harv. L.Rev. 226, 266 (1960), and the latter called forth
the criticism that the "Government always wins," United
States v. Von's Grocery Co., 384 U.S. 270, 301, 86 S.Ct. 1478, 16
L.Ed.2d 555 (1966) (Stewart, J., dissenting). I hope that this case does
not represent an abandonment of that basic, and important, form of
analysis.
For these
reasons, I respectfully dissent from Part III of the Court's opinion.
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