*1 BLUE SHIELD OF VIRGINIA McCREADY et al. v. Argued
No. 81-225. March 1982 Decided June *2 White, Bkennan, Mar- Court, J., in which opinion delivered Rehnquist, Blackmun, Powell, JJ., J., shall, joined. filed a dis- Burger, O’Connor, J., joined, post, J., senting C. opinion, which Stevens, J., dissenting opinion, post, p. 492. p. filed a B. Bell for petitioners. the cause With him argued Griffin Miller, B. Poff, D. William Ronald James on the briefs Ayers, III, Klein, Marshall I. Hernán A. Joel M. Farr H. Bartow III. *3 R. Furr II
Warwick for argued respondent. cause Timothy J. were With him on brief Bloomfield M. Thomas Brownell.* of the Court. opinion delivered Brennan
Justice at issue this case a alleges The antitrust complaint sub- to reimburse health group plan’s practice refusing for performed by psychologists, scribers psychotherapy for treatment by while comparable reimbursement providing of an conspiracy was in furtherance unlawful psychiatrists, The in the market. restrain competition psychotherapy who employed is whether subscriber presented question maintain an ac- of a has standing the services psychologist failure §4 of Act based the plan’s tion under the Clayton upon that treatment. reimbursement for the costs of provide HH 1978, respondent From January 1975 until September County, William of Prince MeCready Carol was an employee Ennis, N. filed a Friedman, *Paul R. and Donald Bruce J. Bersoff curiae urging amicus Psychological for Association brief the American affirmance. the county provided her compensation, of her As part
Va. health group plan purchased a prepaid under coverage with (Blue Shield).1 of Virginia Blue Shield petitioner for a portion reimbursement provided specifically plan to outpatient treat- respect subscribers incurred cost disorders, including nervous psycho- mental for ment Shield Blue reimbursed this provision, Pursuant therapy. provided psychiatrists. for psychotherapy subscribers serv- reimbursement for the not provide Shield did But was supervised by the treatment unless ices of psychologists While a subscriber to the through physician.2 billed a clinical She psychologist. treated McCready was plan, of that for the costs treat- to Blue Shield claims submitted denied because routinely they claims ment, but those billed through physician.3 been had this class action in the United 1978, McCready brought Virginia, for the Eastern District District Court States costs who had incurred all Blue Shield subscribers behalf of Virginia. petitioner Blue Shield of Southwestern With county and Blue the contract between the 2 Petitioners contend nonphysicians. payments for the must read to bar services Shield routinely re Respondent that between 1962and 1972Blue Shield counters by psychologists, and psychotherapy imbursed subscribers that, provided *4 conspiracy. alleged revised in 1972as a result of the practice this was addition, Legislature passed respondent Virginia in 1973 the In notes that statute, (1981), required §38.1-824 of that a “freedom choice” Va. Code by pay psychologists. Blue Shield to for services rendered licensed See Academy Psychologists Virginia, Virginia Clinical v. Blue Shield of of 1980). (CA4 476, argues obligations 624 F. 2d that Blue Shield’s She statute, consistently be read with that at least until statute was must Commonwealth, 221 applied Virginia invalid as in held Blue Cross of (1980). 349, 269 E. Va. S. 2d 827 This on a to dismiss. case arises motion assume, McCready alleged We therefore alleged, as has but for the deny conspiracy payment, she would Blue have been reimbursed Shield for psychologist’s the cost of her services. 3Apparently McCready’s inadvertently Blue Shield of claims. paid one discovered, After the sought error was Blue refund from Shield obtain a paid. for the amount 649 F. n. 4 2d who had not been 1973 but since for services psychological that Blue Shield and The complaint reimbursed.4 Inc., of had Virginia, Society Neuropsychiatric petitioner § 1 in violation of of conspiracy in an unlawful engaged Psy Virginia Academy of Clinical complaint filed A similar was (VACP) against the same defendants. The president its chologists to dismiss filed in each of the cases the motions District Court addressed McCready’s giving case—thus rise single opinion. The court dismissed permitted the VACP at issue this Court —but appellate to the decision trial, judg Following the District Court entered proceed to trial. case to Psychologists v. defendants, Academy Virginia Clinical ment for the of (1979), Appeals but the Court of Virginia, Supp. 469 F. Blue Shield of (CA4 1980). Shield, Blue 624 F. 2d respect to defendant reversed with in the instant Appeals for the Fourth Circuit opinion of Court with” in connection opinion in VACP “should read case states that 2d, A of the decision in F. at 230. brief recitation opinion. own its of helpful understanding precise nature ease is thus the VACP McCready’s claim. treatment VACP, Appeals rejected the District Court’s the Court determining whether entity purposes as a
of Blue Shield distinct 2d, The court 624 F. at 479. conspiracy agreement had been shown. operating physicians, Plans are combinations of found that “the Blue Shield members.” Ibid. physician under the direction and control of their are, they to a though companies, “Blue Plans are not insurance Shield prepaid Rather, they generally characterized degree, insurers. are real [I]n a plans, quantity purchasers health of health care services. care sense, physi- member legal agents Plans of their the Blue Shield are (citations omitted). Id., cians.” at 480 and footnote combina- alleged Blue Shield respect question With to the whether the the Dis- trade,” agreed with Appeals tion “in restraint of was Court District that the applicable, but held trict Court that the rule of reason was Appeals observed finding liability. The Court Court had erred no market, compete psychotherapy in the psychologists psychiatrists extent,” dictate, “necessarily to some Blue and that decisions of Shield Finding Id., psychotherapy. provide who will be chosen to psychotherapeutic for the denying Blue reimbursement Shield’s merely a through physicians, unless billed services of claimed practice,” as “good medical simply cost-containment device or Act. the Sherman Shield, had violated the court held that Blue Shield *5 Ibid.
470 § amended, l,5 15 C. 209, as U. S. Act, 26 Stat.
Sherman from receiv- clinical boycott and “to exclude 55. plans. the Blue Shield App. under” ing compensation failure to reim- Shield’s alleged further McCready alleged conspiracy, of the in furtherance had been burse or for which she property business to her injury had caused attorney’s § fees under 4 to treble was entitled §15.6 731, 15 U. S. C. Act, 38 Stat. Clayton of the dismiss, motion to petitioners’ granted The District Court §4 no under to maintain standing had holding view, McCready’s standing In the District Court’s her suit.7 on whether she had suffered § turned a 4 action to maintain en- economy competitively sector of the the “within violations of the anti- alleged the defendants’ dangered by the of the Noting goal trust laws.” App. from a segment clinical psychologists exclude boycott concluded that market, court of the psychotherapy endangered” by economy competitively “sector of the occu- “no further than that area violation extended charged in Id., 18 (emphasis original). pied by psychologists.” had suffered an Thus, clearly while McCready contract, “[ejvery part, com provides, pertinent in That section otherwise, conspiracy, in restraint of form of trust or or bination in the nations, is States, foreign among or with trade or commerce the several illegal.” declared to be provides, pertinent part: That section property by injured reason “Any person who shall be in his business any district anything sue therefor forbidden the antitrust laws sustained, damages by him . . court. and shall recover threefold the suit, including attorney’s fee.” the cost of reasonable §2 of the McCarran- argued Petitioners have in this that under Court Act, the anti Ferguson exempt § S. C. their actions petitioners' part ruling trust of the laws “business insurance.” dismiss, respondent ade had motion to the District concluded that Court McCarran-Fergu- pleaded boycott beyond protection quately 1013(b). Act, a full fac that on Respondent points son S. out U. C. VACP, against petitioners tual record the issue was resolved question in 2d, this Appeals F. at 483-484. The did not address Court case, however, present it here. and we do not reach *6 was indirect “too injury this reimbursement, denied being Ibid. injury.’” ‘antitrust considered and remote to be for Court of Appeals States the United A of divided panel had al- McCready that reversed, holding Fourth the Circuit §4 of Act the meaning Clayton within the leged injury (1981). 649 F. suit. 2d 228 maintain the standing and had of the alleged conspiracy the goal that court recognized The from some segment clinical psychologists the exclusion of was 4§ it held that the rem- market. But of the psychotherapy loss is “whose di- any person property was available edy violation of antitrust caused the by” or rectly proximately not “too or indi- was remote laws, McCready’s loss that at 231.8 court thus Id., the Act.” The by rect to be covered standing recog “target area” limitation on antitrust Addressing the 14, infra, the Appeals, see n. court concluded nized in several Courts policies underlying implicated limitation were not 2d, judge McCready’s dissenting 649 F. at took a claim. 231-232. McCready contrary “target emphasized He view of the area” rule. violation,” any design goal had “as a antitrust not described her Id., consequence but “rather as a thereof.” at 232. He viewed this as the proper “target in the test to application determinative factor area” the facts of this case: standing sue, determining
“In who at who the has the courts must look illegal injure. bystander, act A who is not intended vic- was aimed to nonetheless, injured tim of the violation but cannot sue antitrust who is Id., under the His 233. laws. is too remote.” at addition, argued not sector of dissent within the violation, economy “competitively agreeing endangered” by the with the District was unre- operated Court that “she in a market which Id., strained so Finally, far as she was the dissent concerned.” at reasoned: price
“The psychologists’ any not act services to her was increased the defendants. The . would not fact that her Blue Shield contract . . reimburse paid her for she nothing price those services had to do with the services, for the artificially which . . . were an antitrust not inflated violation. . . . . higher “. . psychologists’ There is not even a claim are that her bills Id., they
than would have been had conspiracy existed.” 235-236. proceed- further District Court case to
remanded the ings. S. 454 U. granted certiorari. We I—t W provides Clayton Act, 38 Stat. 4 of Section *7 “[ajny person remedy who be in- treble-damages shall to anything property reason for- jured or in his business of §15 (emphasis U. S. C. 15 laws,” in the antitrust bidden added). Corp., U. v. 442 S. Reiter Sonotone in As we noted way § (1979), “[o]n 4 little of contains face, its 337 330, language language.” the lack of restrictive And restrictive enacting purpose” “expansive Congress’ remedial reflects private sought § mecha- Congress a enforcement to create 4: deprive them of the violators would deter nism that provide ample illegal would com- actions, and their fruits of Inc. pensation violations. the victims Pfizer (1978). Brunswick 308, 313-314 See India, 434 U. S. v. 485-486, Bowl-O-Mat, Corp. Inc., 477, 429 U. S. Pueblo v. (1977); Inc. International Mufflers, Perma v. 10, n. (1968); Society Corp., American 139 134, 392 U. S. Parts Hydrolevel Engineers Corp., 556, 456 v. U. S. Mechanical (1982). recognized, “[t]he As have 572-573, and n. 10 we protection or consumers, its statute does not confine purchasers, competitors, . . Act or to . sellers. coverage, protecting comprehensive all who in its terms and practices by whomever are made victims of the forbidden they may perpetrated.” Farms, Inc. Mandeville Island (1948). Sugar Crystal 219, v. 236 Co., American 334 U. S. congressional purpose, have re- with the we Consistent remedy.9 §4 engraft on fused to artificial limitations congres a we of [the In related context the face “[i]n commented that to burden requirements antitrust] sional this Court should not add litigant by Congress . . .” private beyond specifically what is . set forth League, Radovich National Football 445, v. See 352 U. S. Burners, Co., Peoples also Radiant Inc. Gas S. 659-660 364 U. curiam) (To (1961) Act, “allega- (per § state a 1 the claim under Sherman point. India, Inc. v. illustrate the cases Two recent Pfizer statutory phrase “any person” supra, its “natu- afforded the meaning,” rally id., at and held broad and inclusive brought foreign sovereign. it even to an extends action Corp., supra, rejected Similarly, Reiter v. Sonotone ar- § remedy only gument is available to redress In that case we afforded the to commercial interests. statu- “naturally tory “property” its broad and term inclusive mean- § standing ing,” held that a consumer has to seek rem- edy reflecting purchase price goods increase in the conspiracy. price-fixing to a S., was attributable sum, of some the absence articulable consider- statutory policy suggesting contrary ation conclusion a particular setting, applied we have 4 in factual accordance plain language its and its broad remedial and deterrent objectives. drawing statutory policy, But our cases have *8 acknowledged types availability two of limitation on the § remedy particular persons 4 to classes of and for redress particular injury. forms of We limitations in treat these turn.10
A
(1972),
In Hawaii v.
251
we
Co.,
Standard Oil
405 U. S.
parens pa-
4
held that
did not authorize a
to sue
its
State
capacity
damages
“general economy.” Noting
triae
for
to its
action,
and,
damage
tions adequate
private
to show a violation
in a
treble
plaintiff
damaged thereby
requires”).
are all the law
10
course,
will,
Permitting McCready
further
to maintain this lawsuit
§in 4.
objectives
private
certain basic
embodied
of the
enforcement scheme
Only by
illegality” can
requiring
disgorge the “fruits of their
violators to
Hanover
objectives
fully
the deterrent
of the antitrust
laws be
served.
(1968).
Shoe,
481,
Machinery
Inc. v.
Corp.,
United Shoe
392 U. S.
India,
Illinois Brick Co. v.
(1978);
Inc. v.
See
U. S.
Pfizer
Illinois,
allowing Blue Shield
431 U. S.
But in addition to
standing
denying
palpable profit
plan,
to retain a
a result of its unlawful
in the denial of
to
result
represents
and the class she
would also
compensation
injuries resulting
conduct.
for
from unlawful
ultimately
part
“large
indeterminable
of the
that a
economy’
the.‘general
...
is no more than a reflection of
property’
injuries
consumers,
for
the ‘business
which
they
§4,”
themselves under
we
recover
concluded that
expensive
lengthy
trial
.
“[e]ven
could not
. .
the most
recovery
problems
cope
of double
inherent in allow-
quasi-sovereign
ing damages”
to the State’s
inter-
Corp., supra,
v.
264. See Reiter
Sonotone
Id., at
ests.
(1977),
Illinois,
offer no allowing recovery engendered duplicative on the risk of claim of distribution to damages a chain along every person the that violated antitrust from a transaction single arising to the circum- laws. permitting respondent proceed But of a du- slightest this case offers not possibility stances of McCready has her paid plicative petitioners. exaction consists of Blue Shield’s failure bills; her injury psychologist’s can link Her no claim of to to her. pay psychologist he McCready; from his treatment of has been arising himself has injured by for his service and not been fully paid her for the cost his Shield’s refusal to reimburse of services. effect of Blue actions on And whatever the adverse Shield’s it is purchased who not the McCready’s employer, plan, as its subscribers, but as employer purchaser, employees who are out failure to pocket consequence plan’s pay benefits.11 Hawaii and Illinois opinions If is a subordinate to our there theme
Brick, feasibility consequences it is implementing particular may, damages circumstances, theories certain limited be considered in determining §4. who is prosecute brought entitled to under action with purposes laws, Where consistent the broader remedial of the antitrust sought we have burdening damages avoid actions issues giving with theories,” rise to the need for complicated “massive evidence and where the consequence discourage vigorous would be to enforcement the anti Shoe, by private trust laws suits. Hanover Inc. v. Machin United Shoe ery Corp., supra, at recognized we Thus that the task of disen tangling overlapping damages lightly imposed upon claims is not potential Hawaii litigants, upon judicial system. or See v. Co., Illinois, Standard Oil Illinois Co. v. (1972); 405 U. S. Brick supra, addition, at 741-742. “[difficulty while [should of ascertainment Pictures, right Bigelow Radio recovery,” be] confused v. RKO Inc., (1946), S. plainly §4 tangible economic in focuses jury. It therefore be appropriate to a claim rests consider whether at bottom on some conception speculative abstract or of harm. measure See Co., Hawaii Standard Oil supra, 262-263, But like the n. 14. against duplicative recoveries, approach speculative, our cautious ab stract, impractical McCready’s theories application has no suit. The nature of her easily stated: As of an unlawful the result boycott, pay Blue Shield failed to cost she incurred for the services of a psychologist. Her damages and, plan were fixed contract as the *10 476
B
§
4
restrictions
the
rem-
from the
distinct
Analytically
Brick, there is the con-
and Illinois
in Hawaii
edy recognized
have sus-
“of which persons
question
difficult
more
ceptually
remote
to give
too
an antitrust
[from
violation]
injuries
tained
Illinois Brick
§
under 4.”
damages
to sue
standing
them
added).12
Illinois, 431
S.,
728, n. 7 (emphasis
at
v. Co.
U.
of
to cause
expected
ripples
violation
An antitrust
they
penny.”
to the
649
observed,
could be “ascertained
Appeals
of
Court
2d,
231.
F.
at
12
in Perkins v. Standard Oil
of “remoteness”
two issues
We addressed
(1969).
§2 of
alleged
violation of
Co., 395
That case involved
S. 642
Act, 15 U. C.
Act,
by the Robinson-Patman
S.
Clayton
as amended
the
2,§of
we found no warrant in its
terms
on the substantive
Focusing
13.
of
engraft
limitation on the reach
an “artificial”
purpose”
“language or
injury.
a “fourth level”
court below had termed
remedy to
what the
bar
rejected
one form
S.,
the claim that
of
We also
395 U.
at 648.
proximate
viola
result
was not
claimed
the defendant
Id., tion.
jurisprudence
Appeals
developed a more substantial
have
The Courts of
“remoteness,”
subject
formulating various “tests” as aids
on the
employed
are
Among
by the lower courts
those
analysis.
the tests
Co.,
g.,
Loeb v. Eastman Kodak
e.
injury,
on the “directness” of
focus
Inventions,
(CA3
Inc. v. Trico Products
704,
1910);
Productive
183 F.
709
Fry
(CA2
Lloyd A.
Volasco Products Co. v.
1955);
Corp.,
harm
beyond
wording
point
wrong-
broad
of
there
which the
4
Id., at
doer should not be held liable.”
760 (Brennan,
J.,
dissenting).
Congress
to assume
It is reasonable
that
did
every person tangentially
not intend to allow
affected
an
violation to
an
maintain
action to recover threefold
property.
for the
to his business or
Of
statutory language
legislative
course, neither the
nor the
his-
tory
any
guidance
question
§4 of
offers
focused
on the
of
injuries
pur-
which
are too
from the
remote
violation and the
poses
predicate
of the antitrust laws to form the
for a suit
language
§4; indeed,
under
the unrestrictive
of the section,
congressional purpose,
and the
avowed breadth of
cau-
§ ways
tions us not to
4 in
will
cabin
that
defeat its broad re-
objective.
potency
remedy implies
medial
But the
application.
need for some care
its
In the absence of di-
guidance
Congress,
rect
and faced with the claim that a
particular injury
alleged
is too remote from the
violation to
§ standing,
warrant the courts are thus forced to resort to
analysis
traditionally
employed
no less elusive than that
an
respect
“proxi-
courts at commonlaw with
to the matter of
mate cause.”13
Perkins v.
Co.,
See
Standard Oil
395 U. S.
Corp.
Corp.,
Karseal
v.
Oil
642, 649
(1969);
Richfield
principle
proximate
suggests
traditional
cause
the use of words
“remote,” “tenuous,” “fortuitous,” “incidental,”
“consequential”
such as
g.,
See,
e.
injuries
remedy
to describe those
will
law.
find no
at
Producers,
Newton,
414,
South Carolina
Milk
Inc. v.
Council of
360 F. 2d
(CA4 1966).
prin
only emphasizes
And the use of
that the
such terms
See,
g.,
e.
ciple
proximate
hardly
rigorous analytic
cause is
tool.
(1928); id.,
Co.,
Palsgraf
Long
Island R.
Y.
(1)
*12
McCready’s injury
is too
position
It is petitioners’
and “remote”
the al-
“incidental” to
from
and too
“fortuitous”
§4a
At the
the basis
action.14
to
provide
violation
leged
the alleged
that because
argue
conspiracy
outset, petitioners
at
and not at
psychologists,
its
protagonists
directed
was
only psychologists might
health
group
plans,
subscribers
to
be
of.
argument may
quickly disposed
suit. This
maintain
of the conspirators
think that because
goal
do not
We
market
into a
by psychologists
halt encroachment
to
353,
Smith,
Curran,
Pierce,
v.
456 U.
Lynch,
Fenner &
Inc.
S.
rill
(1982);
County Sewerage Authority v. National Sea
Middlesex
377-378
Assn.,
1,
(1981);
Mortgage Advi
Transamerica
Clammers
453 U. S.
sors,
Lewis,
11, 15-16
Inc. v.
444 U. S.
“target
petitioners
test of antitrust
arguing,
advert to the
area”
so
First, Second, and
prevails
standing
Appeals
in the Courts of
for the
See,
g.,
Corp.
Corp.,
Exxon
Fifth
e.
Pan-Islamic Trade
Circuits.
Ltd.,
(CA5
1980);Engine
Bombardier
Specialties,
F. 2d
Inc. v.
(CA1
Art
Corp. v.
1, 18-19
1979);
Enterprises
United
605 F. 2d
Calderone
(CA2 1971).
place
Circuit, Inc.,
Petitioners
ists Theatre
relationships with Id., being ‘targets’ at 1295. spiracy, themselves.” rather than sought preserve for them- psychiatrists physicians to McCready’s “remote.” avail- rendered selves, person remedy who claims its bene- ability some to of the conspirators. specific of the question intent of the fit is not reasonably remedy be restricted to those cannot Here the hoped conspirators to competitors eliminate whom McCready has been the victim claims that she the market.15 part pay moti- Shield, on the refusal of concerted patronage deprive of the a desire vated Denying reimbursement sub- subscribers. Blue Shield very means was the cost of treatment for the scribers sought ille- to achieve its that Blue Shield which it is clearly gal and her class was harm to ends. The necessary step effecting indeed, it was a foreseeable; alleged illegal conspiracy. al- Where the ends of the conspiracy alleged, integral aspect leged there is so “ type precisely question ‘the but that the loss was can be no likely . would claimed violations . . of loss that the Corp. Bowl-O-Mat, Inc., 429 v. Pueblo cause.’” Brunswick Corp. quoting Re- Zenith Radio v. Hazeltine S., *13 Inc., 395 125 search, U. S. § remedy might argue if 4 next that even the
Petitioners competitors persons of the con to other than the available spirators, McCready was not because she it is not available to in restrained. an actor the market that had been economic range petitioners’ proximate is the violation view, of economy of in sector of the which a limited to the violation anticompetitive type alleged direct would have its most pur petitioners market, for Here, effects. that that contend group poses alleged conspiracy, health in of the is the market standing plans. petitioners’ to redress view, in Thus, care Appeals of by Courts “target applied Nor does area” test “ injure the conspirators to ‘imply purpose that it have been a of the must ” Sony Corp. See Schwimmer v. particular claiming damages.’ individual Century (CA2 America, Twentieth 1980), quoting 2d 47-48 F. of Goldwyn, Fox 2d, Corp. Film F. in is limited to participants case in this alleged the violation em entities, McCready’s such as is, to market —that that but not health group plans, purchasers who ployer, Blue Shield plan.16 beneficiary as a McCready Mc- McCready’s complaint. misconstrue Petitioners group in market for restraint allege does Cready on a concerted premised claim of Her plans. health was, fact, purchased plan under reimburse refusal to benefit, that as a for her and- her employer retained re- law permitted and state construction matter of contract any without of psychologists for the services imbursement of the contractual rela- in the structure variation significant 2,n. her and Blue Shield.17 See employer between tionship supra. services entitled psychotherapy consumer of As a it Blue we think clear plan, under the Shield financial benefits . . economy that area of the . was “within conditions” competitive breakdown endangered [that] selectively Bowl- Corp. from Brunswick v. Pueblo 16 Petitionersborrow O-Mat, (1977), Inc., McCready’s §4 claim is arguing 429 U. S. boycott,” any competition “unrelated to reduction caused alleges “is the result of the terms of her insurance she because contract, competition.” Brief for Peti and not the result a reduction Brunswick, Extracting they argue language additional tioners 16. compensa- “McCready would have suffered the identical ‘loss’—but no ‘injury’ long employer, independently in an unre ble as her which acted market, purchase group that did strained continued insurance contract psychologists.” not cover the services clinical Brief for Petitioners (footnote omitted). 16-17 employer’s Nor do we think that her cov decision to retain Shield erage psy despite its continued failure to for the services of a reimburse chologist indeed, employer’s option her to terminate that unexercised —or relationship Although her intervening McCready’s injury. cause —is employer’s purchase plan was in decision to the Blue Shield for her benefit independently McCready’s injury, some sense a factor that contributed *14 coverage may, stage litigation, her under plan at this of the Shield properly accepted given, evaluating en proper as a her focus §4 titlement change to raise a in the claim is on Blue Shield’s plan terms of the to link reimbursement to a subscriber’s choice of one group of psychotherapists over another.
resulting from Blue Shield’s selective refusal to reimburse. In re Multidistrict VehicleAir Pollution M.D.L. 31, No. (CA9 1973). F. 2d
(2) finally injury alleged We turn to the manner in which the Congress’ prohibiting reflects core concerns the antitrust phrase defendants’ course of conduct. Petitioners their argument point McCready’s on this in a manner that concedes participation psychotherapy in the market for services and McCready’s injury rests instead on the notion that does not “anticompetitive” the.alleged boycott. reflect the effect of They psychiatrist stress that did not visit a whose artificially competitive fees were inflated as a result of the advantage gained by he Blue Shield’srefusal to reimburse for psychologists; pay the services of she did not additional sums physician supervise for the services of a bill psychotherapy provided by psychologist; her there that psychologists’ they higher is no “claim her bills are than conspiracy pro- would have been had the In not existed.”18 moting argument, petitioners rely heavily language this Corp. supra. Bowl-O-Mat, Brunswick v. Pueblo Inc., respondents bowling In Brunswick, were three centers complained petitioner’s acquisition who of several finan- cially bowling Clayton troubled centers violated 7 of the Act by lessening monopoly. competition tending to create a seeking damages, “respondents attempted to show petitioner [acquired] close, had re- allowed the centers to spondents’profits 481. The Id., would have increased.” at Appeals theory upon legal re- which Court of endorsed the “any holding spondents’ loss claim based, id., was ‘causally presence in the violator linked’ to ‘the mere compensable re-We at 487. §4, id., market’” was under respondents holding injury alleged by versed, that the type forestall.’” not of “‘the that the statute was intended 2d, (Widener, J., dissenting). F. at 236 *15 Wyandotte Transportation quoting Co. v. 487-488, Id., at Indeed, States, 389 S. Court U. United damages sought profits they respondents “the noted that competition been reduced.” 429 had have realized would added). (emphasis S., at 488 petitioners’ agree of Brunswick as view em- canWe treble-damages principle bracing general recoveries procompetition of the antitrust to the be linked should signifi- petitioners take Brunswick seek to one But laws. petitioners place passage upon which step In a farther. cant reliance, we stated: much
“[Fjor plaintiffs on account of to recover treble injury causally they prove § than must more violations, illegal presence in market. Plaintiffs linked to an say injury injury, prove is which to antitrust must prevent , type, laws were intended to the antitrust which makes defendants’ acts flows from that anticompetitive injury reflect the should unlawful. anticompetitive acts of the violation effect either possible should, short, It be the violation. made type . violations .. would of loss that the claimed ‘the Corp. likely Re- v. Hazeliine Zenith Radio to cause.’ orig- (emphasis in S., Id., 125.” at 489 395U. at search, omitted). inal; footnote
Relying language, petitioners reason on this injury “did not her maintain no action under because can anticompetitive violation. reflect the effect” of limiting. clear in we made Indeed, so Brunswick is not §4 plaintiff relied-upon passage, need not to the a footnote lessening competition “prove in order to recover. an actual [Cjompetitors may prove before be able to competition they actually the market and are driven from thereby in- Thus while n. 14. Id., lessened.” competitive resulting dampening price crease in § po- assuredly type for which market forces is one Corp., 442 tentially Reiter v. Sonotone redress, see offers *16 only injury (1979), remedia- form is not the that S. 330 McCready’s injury plain § was think it 4. We ble under providing pri- sought Congress in a to redress type of a remedy antitrust laws. of the for violations vate purposefully McCready charges a anti- with Shield as the competitive seeks to recover She scheme. attempt consequence of Blue Shield’s as the sums lost to her sought alleges pursue that Blue She Shield scheme.19 to selecting psychiatrists psy- over into its subscribers to induce they required,20 psychotherapeutic chologists services for the was the offer of a Hobson’s of its scheme and that the heart compelled Those subscribers to its subscribers. choice forfeiting visiting psychologist and re- to choose between receiving by forgoing treat- reimbursement imbursement, or practitioner by case, choice. In the latter of their ment the injury have borne in the first would been the antitrust conspirators, competitors inev- instance itably though indirectly by the competi- the the customers of — — psychother- suppressed competition in in the tors the form of injury happened, apy case, former as it the market; the competitors. directly was borne customers of the the McCready pressure, yield did to Blue Shield’s coercive not increase and bore Blue sanction in the form of an Shield’s Although psychologist’s net cost of her services. Brunswick held that a claim of injury arising preservation anti competition purposes [the enhancement of “inimical to the is a claim quite laws,” S., obviously, McCready’s claim trust] 429 U. Most at 488. not in Brunswick she does plaintiff unlike the claim asserted Nevertheless, we seek to competition label increased as a harm to her. injury and agree petitioners relationship claimed that the between the in Bruns conduct, analyzed that which is unlawful in the defendant’s wick, redressability a determining is one factor to be considered particular injury form of under McCready employ the least, sought compel at the Or Blue Shield physician psychologist. services of a addition to those of of the conspirators, a competitor was with the intertwined inextricably she suffered injury inflict sought conspirators here of the conspiracy light market. the psychotherapy from that “flows McCready’s we think within the meaning unlawful” acts makes defendants’ which of congres- the area within falls squarely Brunswick, concern.21 sional
Ill “[a]ny remedy Act Clayton provides Section in the anything prohibited reason of” “by injured person” *17 asserting correct in that dissenting, of course Rehnquist, is Justice laws type be of the the antitrust by plaintiff the must “injury the suffered Rehnquist’s forestall,” dis at 486. But Justice post, intended to injuries with which the unrealistically narrow view of those sent takes concerned, slightest and offers not the hint— might be laws injury help determining in what kinds of are not beyond ipse sheer dixit —to “a example, acknowledges the For dissent amenable to 4 redress. injure go along conspiracy [to to with the retailers’ distributor who refused conspiring business thereby and lost the retailers’ a disfavored retailer] retailers,” 490. The dis against post, . would . . have an action those deal,” is refusal to sent characterizes this circumstance as a “concerted willing acknowledge compensable injury. to the But the thus existence of only pattern group to If a of dissent’s is not the of concerted refusals deal. making psychiatrists conspired boycott until ceased bank the bank inju to psychologists, loans the bank would be able to the no doubt recover plainly, consequence psychiatrists’ ries suffered as a of And the actions. evaluating psychia the the reasonableness under the antitrust laws of conduct, only trists’ we would be concerned with effects not the busi its banking, against ness of psychologists but also on the whom business of the secondary boycott was directed. McCready the many banker and respects the are in simi- distributor larly McCready alleges situated. con- that she has been victim by psychiatrists certed refusal through plan. Shield reimburse McCready consumer, Because is a type of market rather than some other participant, the dissent unwilling might finds itself she acknowledge have suffered a significance form of laws. under the antitrust But under case, participation circumstances of this McCready’s market for psychotherapeutic services provides precisely significance. infer in this case to a limitation We are asked
antitrust laws. by plain language recovery suggested on the rule of §4. precedents having and, im- our more reviewed But portantly, policies laws, we are unable of the antitrust upon any persuasive identify which rationale §4 might she claims. under for the denied redress Appeals judgment The of the Court
Affirmed. Rehnquist, with whom Chief Justice Justice join, dissenting. Justice O’Connor injury” Respondent’s alleged “antitrust this case arises coverage dispute with her insurer, from a health insurance petitioner Virginia. Respondent’s Blue Shield of com- plaint its treat- is that Blue Shield reimburses subscribers for by psychiatrists, psychologists ment but not unless their supervised physicians. treating services are and billed Respondent psychologist, was treated a clinical but when she Shield, submitted claims to Blue she was denied reimbursement.
Respondent alleged complaint in her that Blue Shield’s re- obtaining fusal to reimburse her for the she incurred costs psychologist peti- conspiracy by services furthered a boycott tioners “to exclude and clinical from re- *18 ceiving compensation plan.. App. under” Blue 55. Shield’s policy alleged Blue Shield’s refusal-to-reimburse to consti- pressure McCready tute a form of economic on and other psychiatrists Blue Shield subscribers to obtain the services of psychologists. By employing rather than this economic pressure petitioners subscribers, Blue Shield are placed competitive to have clinical at a dis- advantage regard psychiatrists to the market psychological insurance-reimbursed services. McCready’sinability The Court concludesthat to obtain re- psychological actually imbursement for the ob- services she permits tained her to maintain anti- an action to enforce the According Clayton § to Act. the pursuant 4 of to laws trust necessary step as a loss economic suffers who Court, one the “standing” pur- conspiracy to sue has effecting of a end disagree. I §4. 479, 483-484. Ante, at suant Clayton authorizes suits for treble Act 4 of Section injured his “[a]ny person business by who shall anything in the antitrust by forbidden property reason enough, however, for It a is not S. C. 15 U. laws.” allege violated the anti merely defendant that the plaintiff Corp. injured. Brunswick he and that laws trust 486-489 Bowl-O-Mat, 429 U. S. Inc., Pueblo 251, 263, Co., 405 U. n. Oil S. v. Standard Hawaii See (1972). plaintiff injury must be suffered type intended to forestall. Bruns laws the antitrust supra, Inc., Bowl-O-Mat, at 487 - 488. Corp. v. Pueblo wick say injury, prove which is to must antitrust “Plaintiffs type laws were intended prevent which makes defend- that flows from that reflect the anti- unlawful. The should ants’ acts competitive violation or of anti- effect either of the competitive possible the violation. It acts made type vi- should, short, be ‘the of loss that claimed likely S., olations ... would be to cause.’” (citation omitted). Although McCready alleges have been re- that she would conspiracy, it I imbursed had not been for the do not think injury” allegation that she has made sufficient of “antitrust meaning within the of Brunswick.
Standing in- alone, refusal to reimburse its insurer sured does not constitute Act. At a violation of the Sherman part most, such an action on the of an insurer amount a breach of a contract or a law violation of relevant state regulating industry.1 According Court, insurance to the
1 In claim, addition to McCready’s complaint the antitrust asserts jurisdiction. claim for principles pendent breach contract under the *19 typical distinguishes this case from the insur- however, what coverage purpose dispute is behind or the either ance ef- reimburse. If Blue Shield vio- Blue refusal to Shield’s fect policy, it laws its nonreimbursement lated the antitrust policy putting only used as means of was a because that disadvantage competitive psychologists in relation to aat psychiatrists. grounds therefore be divined from conceivable
Two support McCready opinion its conclusion that Court’s injury” when Blue Shield refused to has suffered “antitrust obtaining psycholo- her the services of a reimburse costs theory McCready may simply gist. first is that recover policy petitioners’ was intended because nonreimbursement competitive disadvantage. put clinical at a According this be so even if Blue Court, to the must Shield’s legal entirely her refusal to reimburse would under purpose competi- of such a antitrust laws in the absence tively injure parties. purpose third Blue intent or Shield’s discriminatory illegal. policy reimbursement renders theory, this it to be irrelevant for the Under would seem purposes Court’s obtained the services of whether illegal psychologist psychiatrist long is a as intent or a so present loss as a result.2 she suffered economic recovery a rule that
The second conceivablerationale is flat permitted persons as a who suffer loss those economic necessary par- step effecting conspiracy place third state alleges contravened App. 57-58. She also that Blue Shield’s Id., law. at 55-56. subscribers, McCready, who did explains The Court that those such as yield sanc pressures to Blue suffer from Shield’s coercive Shield’s psychologist. by way obtaining the services of tions increased costs suffer antitrust yield pressure Those subscribers who did to Blue Shield’s psychotherapy injury indirectly suppressed competition in the because of Ante, to conclude I the Court market. at 483-484. do not understand Illinois, re Illinois Brick (1977), would not bar Co. 431 U. S. situation. in the latter covery by subscriber, opposed psychologist, to a *20 theory, disadvantage.3 competitive Under this ties at a merely by demonstrating may McCready that she recover petitioners’ effort disable was a “tool” psychiatrists competing in the market for insur- may psychological services. She recover ance-reimbursed pressure imposed yield to economic did not she because McCready may theory recover is that because her.4 The on “boycott” petitioners’ a efforts to enforce linked her loss is parties. of third reasoning the Court’s is foreclosed that
I such believe plaintiff a recover, must order to in Brunswick. decision is he of the nature that the demonstrate type suffered illegal. challenged practice In Bruns- that makes § Clayton may merger violated of the well have wick, competitors not before the or even as to Act in the abstract plaintiffs in Brunswick could we held that the Yet, Court. anticompet- they from the did suffer not recover because merger. rejected the contention that We itive effects merger merely that the defendant’s to show it was sufficient that causal link between there existed a 7 and that violated merger In- at 486-489. S., loss. 429
and an economic standing herself theory has suggests a third The Court —that ante, 21; infra, n. at at target a refusal to deal. See as of concerted 490-491. respondent theory, under this it would seem In order recover pres actually yield to the economic prove must at trial she refused If to ob policy. she decided Blue Shield’s reimbursement sure created know psychiatrist without psychologist of a rather than a tain the services “injury” was policy, cannot said that her ing of Blue Shield’s it If she anticompetitive petitioners’ alleged conduct. proximately related to reimbursement, it only then cannot sought she policy discovered the after McCready’s any had conduct be said that Blue Shield’s effect course, This, is psychotherapeutic services. consumer the market for knowledge of a de say person not to that a in all circumstances must have activity. may challenge that anticompetitive one fendant’s activities before oblivi if one acted pressure,’however, of economic One not be victim ously pressure. to that type showing required that the harm suffered is
stead, the challenged practice makes the plaintiff which illegal. Id., merely McCready may by showing not recover
Therefore, resulting prac- loss from a suffered an economic she has *21 depends upon legality which its effect on a third tice the challenged practice McCready party. must show that the is petitioners’ illegal regard upon her. But with to its effect illegal upon policy not virtue of its to be effect is upon psy- of its subscribers but because effect Blue Shield’s McCready alleges anticompetitive upon chologists. no effect allege conspiracy not that the has affected herself. She does availability psychological sought of the services she the and actually allege conspiracy Nor does she obtained. the price affected the of the treatment she received.5 She does allege by any not that her was caused reduction competition psychologists psychiatrists, between nor any that it was the result of success6 Blue Shield achieved in “boycott” psychologists. solely recovery its She seeks on the basis that Blue Shield’s reimbursement failed necessary her alter conduct a fashion to foreclose psychologists obtaining patronage the of Blue Shield’s subscribers. important
If challenged the consideration is whether the practice illegal regard plaintiff, with to its effect on the plaintiff’s purposes then it would be irrelevant for the conspiracy might adversely competition the also on an- affect example, group other level of the market. For of retailers 5By excluding market, psychologists may psychiatrists from the well be able to increase charges services, their for psychotherapeutic which in turn, may raise the insurance charged by McCready, rates Blue Shield. however, alleges no such theory. herself on this Because psychologist, obtained the services of it cannot be said that the injured by pressure the economic placed Shield on McCready represents. and the class of subscribers she ante, See at 475. those distributors with business to do refuse threaten to If retailer. a disfavored with to do business that continue conspiring cooperate the re- agreed to distributors the would have action an retailer disfavored then the tailers, conspiring agreeing retail- against distributors Corp., Motors g., General States v. See, United e. ers. Broadway-Hale (1966); Stores, Inc., Klor’s, Inc. U. S. that a distributor who I would think U. S. conspiracy thereby go along retailers’ with the refused have an ac- would also conspiring business retailers’ lost an action would be based against Such retailers. those tion to deal with the dis- conspirators’ refusal upon concerted the antitrust be unlawful under would which tributor itself case, de- unlike instant would not action, laws. Such prac- challenged anticompetitive pend upon effect party. an ac- upon The distributor would have a third tice caught ground in the middle of an that he was tion attempted *22 participants boycott another of the level boycott boycotted. The he was market, but because competitive disadvantage puts a to those him at distributor conspiracy by the retailers’ who are unaffected distributors agree participate.7 to those distributors who to petitioners McCready, allege en- that however, does not gaged is in a concerted to deal with her. As the Court refusal McCready petitioners 468-470, at has aware, ante, Court, may many pointed by As out a refusal to deal take concerted Ante, in the agree forms. n. 21. I the bank could sue would ability because, Court, hypothetical bank’s Court’s as conceded contrast, adversely By compete to with other banks would be affected. solely my McCready disagreement permits sue Court is that it partici because of an does not to level of the market in which she conspiracy pate. Moreover, McCready allege petitioners’ does not adversely competition psychologists psychiatrists affected between adversely price supply psychothera- such manner as affect the peutic Thus, McCready’s is services available her case as a consumer. clearly distinguishable hypothetical. from that of the bank’s the Court’s by conspiring laws to exclude clinical
violated the antitrust coverage plans, of Blue Shield foreseeably injured conspiracy ap- her. The Court that this parently however, that has also suffi- concludes, engaged ciently alleged petitioners have a concerted gravamen that this is the her, and of her refusal to deal with “McCready alleges complaint: that she has been the by psychiatrists concerted refusal to reimburse victim of a plan.” through Ante, at n. 21. the Blue Shield It merely today holding boycottee is that a be that Court §4. “standing” pre- has to sue under Were this the issue merely I have little doubt that the case, sented this Court would have denied certiorari. McCready simply not, not,
But does and could claim stand- ing target refusal to deal. as the of concerted Neither Blue psychiatrists doing threatened to cease busi- Shield nor McCready if ness with she obtained the services of a psychiatrist. McCready alleges psychologist rather than a only policy she not obtain that under the Shield could by psychologists. If reimbursement for services rendered is to make out a concerted refusal such a claim sufficient any product or then consumer who could not obtain a deal, precise be the claim to service on the terms he desires could McCready alleges importantly, “boycott.” victim of a Most only policy laws that Blue violates the antitrust Shield’s anticompetitive psychologists. She virtue of its effect on any way illegal allege does not that Blue Shield’s because of its effect on subscribers. *23 stating by
The such concerns Court, however, dismisses [McCready] conclusory was injury suffered terms that “the conspirators injury inextricably the the intertwined with psychotherapy mar- sought psychologists on and the to inflict holding is not I trust that the Court Ante, ket.” at 484. merely complaint plaintiff may escape dismissal of the that a “inextricably by alleging economic loss that he suffered an intended, but the defendants with an intertwined” party.8 Although upon a third Court to inflict failed, successfully deciding pecu- may this case on its view itself any wholly provide failed to sort of reasoned facts, it has liar Especially in law, the area of antitrust decision. for its basis analysis necessary. when is do not suffice labels Appeals judgment of of the Court be- I reverse would alleged that she has suffered anti- has cause injury, attributable to a best breach of but trust part of Blue Shield. contract Stevens, dissenting. Justice psychotherapeutic
Respondent of services. a consumer is injured in her has been “business question whether she is The anything by property forbidden reason of antitrust or agreement alleged is an violation The laws.”1 Society Virginia Neuropsychiatric petitioners between to reimburse that Blue would refuse Shield Shield psychologists payments made to clinical subscribers for objec- through physician. charges not billed were conspiracy alleged to induce subscribers tive psychologists. patronize psychiatrists instead of agree- purposes I that the decision, For assume respond- sufficiency analyzing is unlawful. ment helpful damage the situation it is first to consider claim, ent’s any in “inextricably intertwined” McCready’s injury truly If recovery duplicative by psychologists, jury actually suffered the risk suffered practical problems distinguishing the loss and the inherent may either sub mean that her from the loss suffered Brick Illinois both, may psychologists, or but not recover. See scribers Illinois, Co. 431 U. S. by reason injured “Any person property in his or who shall be business any district sue therefor anything forbidden in the antitrust laws resides in which the defendant of the United States in the district court controversy, and respect amount in agent, found or has an without to the suit, sustained, cost of and the recover threefold the him shall attorney’s S. C. 15. including a reasonable fee.” *24 impact conspiracy maximum on would have its which the petitioners’ objective, con- their Given market. the relevant they perfectly if made it clear spiracy would be most effective they they if not be reimbursed con- would to subscribers psychiatrists. For without instead sulted psychologist choicebetween a a subscriber’s information, this conspiracy. psychiatrist affected would not be insurance the Blue Shield did Thus, I first assume that by psychologists performed and that sub- services not cover fully of this aware exclusion. as a class were scribers assumption, subscriber who is a a Blue Shield this On potential has at least three in the relevant market consumer (2) (1) entirely; go may: forgo options. treatment to a He (3) go psychologist.2 psychiatrist; If he exercises his option, may worsen but he will not have suf- first his illness injury cognizable any under the antitrust fered economic option, property his will not laws.3 If he his second exercises him be diminished Blue Shield will reimburse because payment psychiatrist. his If exercises his third to the he option, property will diminished the extent of his his payment psychologist, unreimbursed to the he will have but pre- exchange psychotherapeutic received in services that Bowl-O-Mat, Inc., Corp. Brunswick v. Pueblo 2 In we 429 U. S. “ injury type held that antitrust was limited to of loss that the claimed ‘the Id., Zenith likely (quoting violations . . . would be to cause.’” at 489 Research, Inc., Radio 100, 125). Corp. Hazeltine I would ex 395 U. S. pect likely that the most to cause violation this case would be knowledgeable potential psychother- members of the class of consumers of apeutic It is fair option. services to second exercise either first or the her respondent to assume that the finds third situation —the one in which “unlikely” self —would be result. if undergo The subscriber have treatment later more extensive forgoes Any he eco consequential treatment now and his illness worsens. however, injury, nomic than the would no more constitute forgo purchase economic suffered a consumer who decides to ground artificially price goods fixed at an or services was high level. *25 The fact that he volun- the payment.4 worth were
sumably for services not covered his by money to spend elected tarily than greater legal significance have no would insurance a who was not Blue aby person decision voluntary a similar to me that whatever thus seems clear It subscriber.5 Shield exercises, he would suf- subscriber informed fully the option reason of the restriction by to his property fer no injury services performed to psychotherapeutic coverage insurance by psychiatrists. the fact that Blue Shield by is reinforced conclusion
This a going psycholo- option the additional have subscribers to reimbursement under the their retaining rights while gist Blue Shield complaint, According respondent’s policy. all made subscribers payments by to reimburse refuse did not through those not but billed only payments to psychologists, preference if a informed subscriber’s fully Even a physician. by were protected over psychiatrists for psychologists the anti- by was not denied laws, that preference antitrust choice de- in this case.6 The Hobson’s violation trust by by psychiatrist psychologist a a and treatment If treatment option effectively fungible, third then a subscriber who exercised this service, in once to the paying psychotherapeutic twice for the would pay premiums unreimbursable psychologist once to in an surer option presumably indicates ment. But the subscriber’s exercise of this by by him treatment psychologist treatment valuable to than is more true, as psychiatrist. If the subscriber is the same situation that be purchased any for which he has policyholder who desires service insurance. by purchase If the subscriber would a service that was covered policy, surgical operation, be reimbursed Shield such as a then he would peti respondent’s If claim is payment. Blue Shield for that antitrust is manifest engaged boycott, tioners have in an unlawful it therefore deal refused to respondent boycottee. petitioners For have not not the any sub coverage other her respondent they offer the same — potential scriber or subscriber. (if be re any) referring physician would 6 Presumably, charge event, not claim any complaint does policy. imbursable under charge. any based such unreimbursed simply Court, ante, does not fit this scribed case. availability option of this fourth would seem to indicate respondent, fully scope in fact, was not aware of the policy’s coverage. understanding
her If her lack of deception, caused fraud or she should be able to recover in misunderstanding a common-law If the was her action. own provide fault, that circumstance should not a basis for an recovery if that would not be available she had been *26 fully informed. deficiency respondent’s complaint
Nor is the if cured assumption coverage about insurance is reversed. Although her antitrust claim would be more if credible Blue coverage performed by psycholo- Shield excluded of services gists, alleged respondent complaint in the second count of her policy, properly appli- that the insurance construed under principles Virginia provided coverage cable law, for serv- performed by psychologists, ices but that Blue Shield never- payments theless refused to reimburse her for the she made psychologist. to her If a subscriber does not suffer antitrust coverage when the insurance excludes serv- performed by psychologists, ices it would be anomalous to availability conclude that the of a claim breach-of-contract any way standing. right would enhance his re- cover under the federal antitrust laws cannot be derived from right to recover under state law. respondent’s complaint
Because discloses no basis for concluding property that she has suffered an to her respectfully reason of I violation, dissent.