Senator Clinton laid out a major plank in her framework for providing
affordable, quality health coverage for all Americans: her 7-step strategy
for lowering spiraling costs.

The rising cost of health care is threatening working families, American
businesses, and the nation’s economic competitiveness. Premiums have almost
doubled since 2000 - up 87 percent - four times higher than wages. And if
left unattended, health care spending will double to $4 trillion per year
over the next 10 years. Senator Clinton stressed that the necessary
commitment to cover all Americans will require the reform of our often
irrational, inefficient and wasteful policies.
Senator Clinton proposed a series of initiatives that will cut the spiraling
rate of growth by one-third over time. Her health care modernization
strategy achieves this by targeting the drivers of health care costs,
including (1) our back-ended coverage of health care that gives short-shift
to prevention, (2) the nation’s reliance on an antiquated, wasteful, costly
and even dangerous paper-based medical records system, (3) unmanaged chronic
illnesses such as diabetes and heart disease which account for over 75
percent of health care spending, (4) the over-utilization of medical
interventions that provide little added value and the under-utilization of
those that do, (5) and excessive insurance, drug, and malpractice costs.

Senator Clinton’s proposals would reduce costs and improve quality in the
health care system. Taken together they would lower national health spending
by at least $120 billion dollars a year. If businesses received a
proportionate reduction in their health benefits spending, they would
achieve at least $25 billion in savings in 2004 dollars. Families would
substantially benefit as well. In fact, Business Roundtable has estimated
$2,200 in national health savings for the typical family. And these savings
would be reinvested in the system to help cover the 45 million uninsured.
To achieve this goal, Senator Clinton’s strategy would:

1. A Groundbreaking National Prevention Initiative to Reduce the Incidence
of Such Diseases as Diabetes and Cancer that Impose Huge Human and Financial
Costs
2. Institute a New "Paperless" Health Information Technology System
3. Transform Care of Today’s Chronically Ill Population to Improve Outcomes
and Decrease Costs
4. Ending Insurance Discrimination to Help Reduce Administrative Costs
5. Create an Independent "Best Practices" Institute to Empower Consumers,
Providers and Health Plans to Make the Right Care Choices
6. Implement Smart Purchasing Initiatives to Constrain Excess Prescription
Drug and Managed Care Expenditures
7. Put in Place Common-Sense Medical Malpractice


This century’s plague is chronic illness including diabetes, heart
conditions, obesity and other chronic conditions. Obesity rates have doubled
among adults over the past 20 years; in fact Medicare could save over a
trillion dollars over 25 years if obesity among seniors could be returned to
levels in the 1980s. One out of three children born in 2000 is at risk of
developing diabetes, and today’s children are at risk of having shorter life
spans than their parents - for the first time in our nation’s history.
Chronic illness accounts for 75 percent of health costs, and two-thirds of
recent cost growth. Only half of recommended clinical preventive services
are provided to adults, and less than half of adults had their doctors
provide them advice on weight, nutrition, or exercisei. Only 38 percent of
adults receive recommended colorectal screening and roughly 20 percent of
children do not receive recommended immunizations.ii
Senator Clinton will:

· Require all insurers participating in federal programs to cover prevention
priorities: Senator Clinton would make it a condition of doing business with
the Federal government that health plans cover high-priority preventive
services. Covered services would be based on recommendations from the U.S.
Prevention Services Task Force. Insurers would provide both individuals and
providers with the financial incentives, such as eliminating copays for
high-priority prevention services. This approach is being taken by such
businesses as Safeway, which not only covers all preventive services but
provides an integrated health promotion model for many of it employees.
· Target prevention by coordinating and pooling public funding: Senator
Clinton would coordinate public spending on prevention across federal
programs in the Department of Health and Human Services to maximize
high-priority prevention. A public-private collaboration would ensure that
prevention is pushed outside of the boundaries of the health care system and
into schools, workplace, supermarkets and communities through free provision
of preventive benefits. It would enlist a new prevention workforce including
pharmacists, church leaders and others who can best use funds to ensure 100
percent use of cost-effective prevention.

Billions of dollars and millions of mistakes result from the use of an
outdated, paper-based medical records and billing systems. Modernizing our
health care system through the use of information technology will empower
doctors and other healthcare providers to communicate electronically and
will reduce waste and redundancy while improving safety and quality by
reducing medical errors. Today, 75 percent of health care claims are
submitted electronically. However, only 71 percent of these claims are
automatically adjudicated (i.e. processed without any manual intervention).
Paper claims that are clean (no manual intervention) cost about $1.60 per
claim; however, electronic claims cost almost half that amount ($0.85)iii.
And claims that require manual intervention/adjudication cost 40 percent
more than an electronic claims.
Senator Clinton will:

· Create system-wide savings from full use of health information technology
and bring a paperless revolution to health care: Require providers
participating in federal programs to adopt private, secure, and
interoperable technology
· Provide one-time financial assistance: An up-front and phased-out $3
billion a year investment fund would be provided to help hospitals and
doctor’s offices to adopt and implement HIT.
· Maximize use and improve quality: Health IT is a critical tool for
ensuring patients receive the highest quality care. The proposal will give
doctors financial incentives to adopt health IT and facilitate adoption of a
system where high quality care and better patient outcomes can be rewarded.
· Reduce 200,000 adverse drug events: If all hospitals used a computerized
physician order entry system, the tragic results of medication errors could
be avoided and roughly $1 billion per year could be savediv.
· Save $77 billion: RAND estimates net savings to be $77 billion per year.
If IT impacted the nation's healthcare system as much as it impacted the
wholesale and retail industry - savings could be as high as $346 billion
annually according to the series of RAND studies-over 15 percent of health
care spendingv.

The largest driver of health care costs in the nation is related to the
small numbers of Americans who incur catastrophic expenditures, usually for
the care of chronic diseases. These diseases, such as cardiovascular disease
and diabetes, account for 75 percent of our total national health
expenditures and are the leading causes of death in the U.Svi. In fact, the
23 percent of Medicare beneficiaries who suffer from five or more chronic
illnesses account for 68 percent of total spending in the Medicare
programvii. A recent RAND study projected nearly $30 billion in national
health expenditure savings per year after implementing disease and lifestyle
management programs. Combined with prevention and health information
technology, with full participation, the U.S. health system could save $147
billion alone for better care of this vulnerable populationviii.
Senator Clinton will:

· Ensure higher quality and better coordination of care: Senator Clinton
proposes using state-of-the-art chronic care coordination models within
federally-funded programs such as Medicare and the Federal Employees Health
Benefits Program (FEHBP), to provide care for Americans afflicted with these
costly, multi-faceted and difficult to manage illnesses. Based on the
concepts promoted by primary care physician groups, Senator Clinton would
permit multi-specialty clinics (such as the Mayo Clinic), private plans
(such as Evercare and the On Lok program in San Francisco), and
provider-sponsored organizations to bid on and provide coordinated care
services.

· Provide incentives for participation in chronic care management programs:
Services provided would include: care coordination among and between
providers, drug management, diet and exercise counseling, lifestyle
management, and the promotion of patient responsibility for self-management.
Medicare beneficiaries and federal employees could choose to opt-in to this
program and many would do so because of the additional services (many of
which would have no cost-sharing requirements) and the potential for
higher-quality care and outcomes. Physicians providing services within these
programs would receive management bonus payments to compensate for their
cost-effective coordination services.

Insurance is about spreading risk across a group of enrollees, yet insurance
companies in the U.S. often discriminate against those with expensive,
pre-existing conditions. A recent study showed that insurance companies in
America spend tens of billions of dollars per year avoiding costly
beneficiaries. Insurance companies’ profits skyrocket by steering clear of
expensive beneficiaries and misusing utilization management techniques for
plan enrollees. Further, recent research has shown that health
administrative costs in the U.S. total at least $294 billion, and the
overhead for private insurers averaged 11.7 percent -- exceeding Medicare
(3.6%) and Medicaid (6.8%)ix. In a reformed system where all Americans are
covered and risk is spread extensively, administrative costs could be
reduced by billions of dollars.

Senator Clinton will:
· End discriminatory insurance practices: A "guarantee issue" system will
build on the concept of shared responsibility by allowing anyone to join a
plan. It would not relegate high-cost people to separate plans or public
programs. In addition, insurance companies would not be allowed to carve out
benefits or charge higher rates to people with health problems or at risk of
them.
· Reduce marketing costs and improve value for the premium dollar: Insurers
would compete on low costs and high quality, not on successful underwriting
and deceptive marketing practices. By insuring all Americans through
accountable public and private plans, we can wring out administrative costs
that do nothing but add to the bottom line.
· Enact uniquely American and bipartisan health reform for all: Success in
covering all Americans will not only provide desperately needed coverage and
security, but also reduce administrative costs in U.S. by as much as $20-30
billion a yearx.

Patients, providers and payers would benefit from getting better information
on what works in health care and how treatments compare to one another.
Little is known about how these procedures stack up, so we end up paying for
them all, even when they may do nothing to improve health. Researchers at
Dartmouth have found that more care is not better care, and that inefficient
care may do more harm than good. Health care providers and patients are
being bombarded with information. In the past decade, there has been an 80
percent growth in the number of drugs prescribed, 100 percent growth in new
device patents, 300 percent growth in teaching hospital procedures, and
1,500 percent growth in diseases with gene testsxi.

Senator Clinton will:
· Create a Best Practices Institute: A new Institute would be created,
funded by both the private and public sectors, since its results will
benefit all payers. Research will compare the effectiveness of alternative
treatments such as pharmaceuticals, devices, and surgical interventions. For
example, information supplied by organizations such as the Drug
Effectiveness Review Project (DERP) has been used in North Carolina to
educate providers and improve quality of care, saving the state an estimated
$80 million in 2003. According to Congressional Budget Office Director
Orszag, there is "an amazing opportunity in this long-term fiscal challenge
to take cost out of the system without harming health...and that opportunity
is remarkable." This research will facilitate the development of quality and
outcomes measures.

Americans pay the highest prices in the world for drugs, and no other nation
spends what we do for health insurance. In the last decade, prescription
drugs accounted for 15 percent of the total increase in health spending,
despite the fact that they account for only about 10 percent of all health
spendingxii. When Congress passed the Medicare prescription drug benefit,
language was included to explicitly prohibit the Secretary of HHS from using
the purchasing power of the federal government to negotiate lower
prescription drug prices. Excess expenditures are not limited to
prescription drugs. MedPAC, a non-partisan congressional advisory committee,
reports that Medicare pays private managed care plans, on average, 12
percent more than traditional Medicare pays to providers to treat the same
beneficiaries. This has raised Medicare premiums by $24 for all
beneficiaries, even those not enrolled in these private plansxiii. The
Medicare actuaries report that these overpayments are accelerating the
depletion of the Medicare Trust Fund by 2 years.

Senator Clinton will:
· Remove barriers to generic competition: Eliminate loopholes in federal law
that allow drug companies use the courts to prevent generic competitors from
coming market. Increase funding for the Office of Generic Drugs at FDA to
eliminate the backlog of generic drug applications. A one percent increase
in the use of generic drugs could yield $4 billion in government savingsxiv.
· Create a pathway for biogeneric competition: Give FDA the authority to
approve safe and effective biogeneric drugs -- ending the monopoly currently
enjoyed by large biopharmaceutical companies. Creating biogeneric
competition will spur innovation resulting in lower costs and more choices
for patients, providers and employers. Providing such competition will save
$5-7 billion per yearxv.
· Allow Medicare to negotiate lower drug prices. Eliminate the prohibition
in federal law that prohibits the Secretary of HHS from negotiating
prescription drug prices in Medicare.
· Provide more oversight of drug advertising, marketing excesses and
inappropriate financial relationships with providers. Limit
direct-to-consumer advertising, institute reporting requirement for
financial arrangements between providers and manufactures, and protect
physician prescribing data from being sold to pharmaceutical manufacturers.
In 2000, for every dollar spent on direct-to-consumer advertising,
pharmaceutical sales increased by $4.20xvi.
· Medicare to crack down on overpayments to private plans: Reduce
overpayments to private managed care plans and move toward a level playing
field in the reimbursement of traditional Medicare and private managed care
plans.

In order to ensure greater stability and predictability for physicians to
continue to practice, we need common-sense medical malpractice reforms.
While some have overstated the role that malpractice insurance plays in the
health care crisis, it is clear that we have to find a way that works for
everyone, doctors and patients alike.

Senator Clinton will:
· Promote medical error disclosure and provider-patient trust:Senator
Clinton has introduced the National Medical Error Disclosure and
Compensation (MEDiC) Act. It would encourage the adoption of a model that
provides liability protections for physicians who disclose medical errors to
patients and who offer to enter into negotiations for fair compensation.
Overall, these policies have resulted in greater patient trust and
satisfaction, more patients being compensated for injuries, fewer numbers of
malpractice suits being filed, and significantly reduced administrative and
legal defense costs. At the University of Michigan, this program has saved
$1-3 million in litigation costs.

Overall Health Costs Crisis and Impact of Reform
· Costs are high and rising: U.S. health care costs are the highest in the
world, now total $2 trillion and expected to double to $4.1 trillion in
2016xvii. In that year, health spending will comprise nearly one-fifth of
the entire economy.
· U.S. spends more for less: On a per-person basis, this is 50 percent
higher than the next nation, and twice the average of competitor nations.
Our spending if $6,100 in 2004 was significantly higher than that of the
next most expensive nation, Switzerland, where the average life expectancy
is 3 years longerxviii. A recent analysis found that, controlling for
income, the U.S. spends $477 billion more than peer nations on health care.
· Impact on businesses: In 2005, businesses financed $367 billion of private
health insurance premiumsxx; by 2008, with current cost trends, this could
climb to $450 billion. One analysis found that health costs in Fortune 500
companies could exceed their profits by 2008xxi.
· Impact on families: Premiums for employer-sponsored insurance have risen
87 percent since 2000, compared to a 20 percent increase in wages. The
average family premium in 2006 was $11,480xxii. Median income in the U.S.
dropped by nearly $1,300 between 2000 and 2005xxiii.
· Generally, reform lowers national health spending: Comprehensive reform
plans have the potential to reduce national health spending, even with the
federal investment in insuring all Americansxxiv.

Preventing and Managing Disease
· Epidemic of chronic illness: An estimated 45 percent of Americans had a
chronic illness in 2000. This is projected to rise to 50 percent by 2020xxv.
o Diabetes: The number of people with diabetes has doubled in the past
fifteen years, with the expectation that one-third of the people born in
2000 can expect to have diabetes in his or her lifetimexxvi. And this trend
is even more disturbing for African Americans: the rate of diabetes is 50 to
80 percent higher for this group compared to non-Hispanic whites.
o Obesity and health: About 24 percent of Americans were obese in 2005, up
from 15 percent in 1995xxvii. Obesity contributes to a wide range of chronic
conditions, from diabetes to stroke to cancer. If trends continue, children’
s life spans may be shorter than that of their parents for the first time in
about a centuryxxviii.
· Chronic diseases drive costs. Chronic diseases, some of which can be
prevented, account for more about 75 percent of health care costs. In
addition, about two-thirds of the rise in health care spending is associated
with a rise in the prevalence of treated disease-more diabetics, more
pulmonary disorders, etcxxix. Medicare is particularly affected: chronic
diseases account for 68 percent of program costs, and 23 percent of
beneficiaries have 5 or more chronic diseasesxxx.
o Obesity and costs: About 30% of the rise in health care spending is linked
to the doubling of obesity among adults over the past 20 yearsxxxi. Had the
prevalence of obesity remained the same today as it was in 1987, we would
spend 10 percent less per person - approximately $200 billion - on health
care today.
o Impact on employers: About 30 percent of total cost of diabetes results
from work loss, disability, and premature death and the effects of
preventable influenza present a major cost to employers in terms of sick
days and reduced productivityxxxii.
· Proven prevention is underused and undervalued
o Low use: Only half of recommended clinical preventive services are
provided to adults and less than half of adults had their doctors provide
them advice on weight, nutrition, or exercisexxxiii. Only 38 percent of
adults receive recommended colorectal screening and roughly 20 percent of
children do not receive recommended immunizationsxxxiv. Additionally, the
percent of elderly people who received an influenza vaccine in 2003 was 64
percent in the U.S., well below Australia at 79 percent and the United
Kingdom at 71 percentxxxv.
o Difficult to provide only through insurance: Health insurers typically do
not cover the full range of recommended services. An employer survey found
that only 57 percent cover flu vaccines, 20 percent cover tobacco cessation
services and only 18 percent cover alcohol problem preventionxxxvi. Since
people frequently change insurers, insurers have little incentive to invest
in them. The average person in their 40s has already had 11 jobsxxxvii.
o Difficult to provide only through doctors: One study estimates that it
would take over 7 hours per day to deliver all of the U.S. Preventive
Services Task Force-recommended clinical prevention to a typical patient
panel of 2,500xxxviii. Moreover, our payment system does not value
prevention. Reimbursement for a diagnostic, surgical, or imaging procedure
often is three times as much as a thirty-minute visit with a patient
involving management and counselingxxxix.
o Low spending: The U.S. spends only an estimated 1 to 3 percent of national
health expenditures on preventive health care services and health
promotionxl. This is an estimated $70 billion per yearxli.
· Primary prevention can reduce costs and improve lives
o Immunization: Fully vaccinating all seniors against the flu could save
nearly $1 billion per yearxlii. Full vaccination of seniors against
pneumococcal disease could save $10 for every $1 spentxliii.
o Obesity intervention: If obesity among the elderly were to return to the
level in the 1980s, then savings could total a trillion dollars over a 25
year periodxliv.
o Workplace wellness: A systematic review of this literature evaluating
workplace health promotion programs found that 88% of the 32 studies found
that these initiatives reduced healthcare costs, and virtually all found
they reduced absenteeism. The mean return on investment of the initiatives
was $3.93 for health care costs and $5.07 for absenteeism savingsxlv.
o Safeway example: Safeway covers all preventive care services appropriate
for a patient's age group. It offers other benefits, such as a 24-hour hot
line staffed by registered nurses, services to help people manage chronic
conditions and incentives designed to promote healthier lifestyles. Safeway
has integrated a health promotion/prevention model with care management.
According to Safeway’s analysis, overall, health coverage costs for Safeway
employees enrolled in the new plan fell 11 percent in 2006, its first year
of operation. It has projected that their 2007 spending will be flatxlvi.

· Chronic care management can produce savings:
o Example of diabetes care management: A comprehensive program to achieve
and maintain weight reduction of 7% among adults with elevated blood sugar
produced results so dramatic and quick, randomized trial was stopped a year
early. The incidence of diabetes was 58 percent lower among at-risk
individuals enrolled in the lifestyle intervention than the control group.
The results were most pronounced among those aged 60 and older - a 71
percent reduction in the incidence of diabetes. These results have been
replicated in studies in Finland and Chinaxlvii.
o Example of warranty for care: Geisinger Clinic has experimented with a
model that provides all follow-up care for up to 90 days after surgery
through a "warranty". This has resulted in more aggressive follow-up (e.g.,
ensuring antibiotics or aspirin are used) and fewer subsequent
hospitalizationsxlviii.
o Example of the VA’s use of HIT and chronic care management: Between 1993
and 1999, the VA adopted electronic medical records, developed explicit
evidence-based treatment protocols for chronic disease, and provided
financial incentives to VA health centers to improve care outcomes. Quality
of care indicators improved dramatically: VA patients received 67 percent of
clinically recommended care compared to 51 percent nationallyxlix. Moreover,
use of hospital services declined dramatically—total hospital bed days
declined by:
§ 51 percent for those with chronic obstructive pulmonary disease,
§ 49 percent for those with pneumonia,
§ 43 percent for those with heart failure, and
§ 49 percent among diabetics.

Health Information Technology
· Medical mistakes: In part due to our lack of health information
technology, an estimated 195,000 Americans die each year due to medical
mistakes. At least 1.5 million people - are ere given the wrong medication
each yearli.
· High cost of paper-based payment: Today, 75 percent of health care claims
are submitted electronically. However, only 71 percent of these claims are
automatically adjudicated (i.e. processed without any manual intervention).
Paper claims that are clean (no manual intervention) cost about $1.60 per
claim. Claims that require manual intervention/ adjudication cost over $2
per claim. However, it costs 85 cents for an electronic claimlii.
· Lowers medical errors: If all hospitals used a computerized physician
order entry system, an estimated 200,000 fewer adverse drug events would
occur, saving roughly $1 billion per yearliii.
· Savings from duplication of tests: A local study in Santa Barbara found
that one in five lab tests and x-rays were ordered solely because the
previous results could not be foundliv.
· System-wide savings from full use of HIT: RAND estimates net savings of
$77 billion per year with 90 percent adoption. If efficiency in the nation's
healthcare system increased by an additional 1.5 percent per year - what
economists generally agree was the impact of information technology on the
wholesale and retail industry - savings could be as high as $346 billion
annually-over 15% of health care spendinglv.
· Example of the VA: The HIT system, known as the Veterans Health
Information Systems and Technology Architecture (VistA), provides clinical,
financial and management systems for the VA. The health record component of
VistA, the computerized patient record system (CPRS), is used in outpatient,
inpatient, mental health, intensive care unit, emergency department, clinic,
home care, nursing home and other settings. CPRS contains all components of
a patient’s health record, such as laboratory test results, medical images,
bar code medication administration, progress notes, and appointments. CPRS
permits VHA clinicians to access a patient's record from anywhere within the
health enterprise, at the point of care. The CPRS is fully operational at
all medical centers and most other VHA sites of care. The VA efficiently
delivers some of the best quality health care in the United States. Between
1999 and 2003, the number of patients enrolled in the VHA system increased
by 70 percent, yet funding (not adjusted for inflation) increased by only 41
percent. Health care spending per capita averages $6,300 in the U.S.; at the
VA, however, the per-patient cost is $5,000, 21% lower than the national
averagelvi.

Reducing Drug and Insurance Costs
· Drugs continue to drive costs: In the last decade, prescription drugs
accounted for 15 percent of the total increase in health spending, despite
the fact that they account for only about 10 percent of all health
spendinglvii. In 2002, patented drugs cost 67 percent more in the U.S. than
in Canadalviii.
· Promoting generic drugs: While 53 percent of all prescriptions are generic
medicines, they account for only 12 percent of total pharmaceutical costs. A
1 percent increase in the use of generic drugs could yield $4 billion in
government savingslix.
· Direct-to-consumer advertising: In 2000, for every dollar spent on
direct-to-consumer advertising, pharmaceutical sales increased by $4.20lx.
· Medicare overpayments to private plans: MedPAC has found that private plan
payment rates are about 12 percent higher, on average, than traditional
Medicare pays to treat the same beneficiaries. This has raised Medicare
premiums by $24 for all beneficiaries, even those not enrolled in such
planslxi. CBO reports that the cost to the budget is $54 billion over 5
years, and about $160 billion over 10 yearslxii. The Medicare actuaries
report that the overpayments are depleting the Medicare Trust Fund: and
advancing the date that Medicare Hospital Insurance will become insolvent by
2 years.

Research for a Value-Oriented Health System
· Proliferation of options: Health care providers and patients are being
bombarded with information. In the past decade, there has been an 80 percent
growth in the number of drugs prescribed, 100 percent growth in new device
patents, 300 percent growth in teaching hospital procedures, and 1,500
percent growth in diseases with gene testslxiii.
· Need for improved quality: Adults get recommended care only about 55
percent of the timelxiv.
· Use of comparative effectiveness information: Information provided by the
Drug Effectiveness Review Project (DERP) has been used by some states in
setting policy. For example, North Carolina used this information to educate
providers, saving the state an estimated $80 million in 2003lxv.
· Example of need for comparative effectiveness: Today, more than 45 million
people - 26% of adults - are diagnosed with arthritis. That figure is
expected to jump to 67 million by 2030. The total costs attributable to
arthritis and other rheumatic conditions (AORC) in the United States in 2003
was approximately $80 billionlxvi. The current therapy for rheumatoid
arthritis (RA) is based on disease-modifying antirheumatic drugs (DMARDs).
And today, new DMARDs are being developed which offer hope for better
prevention and control of the pain and disability associated with rheumatoid
arthritis (RA). But we have little information on the safety and
effectiveness of new DMARDs as compared to traditional DMARDs.

Administrative costs:
· Administrative costs drive our costs above our competitors: The U.S. pays
6 times more per person on administrative costs ($412 per capita in 2003)
than similar nations, partly due to the complexity of and cracks in the
system. Of the $98 billion in excess administrative costs, $84 billion came
from the private sector, where 64 percent of the administrative costs were
incurred due to underwriting health risks, and sale and marketing, costs
that aren't in public systems of most OECD countrieslxvii.
· Administrative costs exceed spending on long-term care and public health:
In 2007, roughly $167 billion will be spent on administrative and private
insurers’ overhead. This is more than will be spent on nursing home care
($132 billion) and public health ($66 billion)lxviii.
· Significant savings could result from simplified administration: Most
estimates of the impact of comprehensive reform plan suggest savings due to
pooling and reduced administrative costs for small firms. A recent analysis
of one plan suggests that system-wide administrative savings could be $30
billion a yearlxix.

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Urban Area Vaccination Coverage among Children Aged 19-35 Months: United
States."
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Health Care Claims Receipts and Processing Times Washington, DC: AHIP.
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Joan F. Ashwell, Chair
Strafford County Democratic Committee
15 Bayview Rd.
Durham, NH 03824
(603) 868-3775
www.straffordcountydemocrats.org