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Clinton Targets Health Care's Voracious Paper Tiger : Medicine: Mountains of records serve as backdrops as President and First Lady stump for reform agenda. Simplified claim form is proposed.


WASHINGTON — President Clinton, promoting his health reform plan, toured the paper-choked room of a hospital Friday to dramatize his claim that an insurance-driven paperwork explosion has increasingly kept America's physicians from giving full attention to the sick.

Holding up a single-page claim form his plan might use, Clinton told an audience at Children's National Medical Center that the nation is "stuck in a system where we're ruled by the form and have less time to make children and adults healthy."

Separately, Clinton hinted that his Administration might charge employers of 5,000 or more workers a special surcharge if they choose to buy their own insurance rather than join huge insurance purchasing cooperatives envisioned by the plan. Talking to reporters Friday afternoon, Clinton said that no final decision has been made but that a "good case" could be made for a special charge amounting to 1% of payroll.

Administration aides said earlier this week that a charge of 0.2% to 0.7% of payroll might be levied on such large corporations to discourage them from dropping out of the new system. The money would go to the huge subsidy pool that would help pay for medical research and for care for small businesses and low-wage employees.

The hospital tour, which came on the second day of promotional events for the plan, dramatized the paperwork reduction effort that is one of the most popular parts of Clinton's complex and controversial health program. Hillary Rodham Clinton, meanwhile, toured clinics in Minnesota and also talked about the need to cut overhead.

The President was shown a record room where the paperwork is said to grow by 6.5 linear feet a day. Officials also showed Clinton four patient files that they said involve $14,000 in paperwork costs. They said that hospital physicians could have conducted 10,000 patient exams if they had been spared that effort.

With 1,500 insurers requiring different paperwork, the system now devotes more than 20% of its revenue to administration, Clinton said. The number of hospital administrators has been increasing at four times the rate of physicians, and the average physician spends 3 1/2 weeks a year filling out paperwork.

"It wastes their time and the patient's money," said Clinton.

One hospital pediatrician, Lillian Beard, related how she had been forced to tell one patient that she could not spend more time with him because of paperwork. She asked: "Free me from the shackles and paperwork of this maze."

The Clinton Administration would require all health plans to use a single standard form by Jan. 1, 1995. Aides have conceived four single-page forms: one for institutions such as hospitals, another for pharmacies, a third for dentists and a fourth for doctors and other providers.

The prototype handed out Friday had 85 separate boxes and asked, among other things, the diagnosis, codes for the medical procedures, covered and uncovered charges, co-payments and site of the service provided. The Clinton plan calls for various other steps as well to trim overhead, including the use of a national health card, computer record-keeping and simplification of Medicare and Medicaid information requirements.

Many experts have said that they believe such a simplified form can be developed, although sizable technical hurdles remain. Health reformers of other stripes, including Republicans and most of the major health-industry interest groups, also support the idea of paperwork simplification, although insurance companies are hesitant about changes that might reduce the information they believe they need.

The insurance industry might object to changes in the current system for another reason: About 5% of claims are lost or forgotten and never reach insurers, according to some estimates. That represents a sizable savings for the companies.

Gail Wilensky, the top White House health and welfare official in the George Bush Administration, said that the government "would be doing well" if its reforms could squeeze $20 billion to $25 billion from a system that, according to various estimates, now spends $100 billion to $200 billion on administration.

"That's nothing to sneeze at, though it's not enough to provide health reform for the millions," she said.

But some critics maintain that the "managed competition" model embraced by the Administration would by definition never be lean because it involves insurers watching over doctors to ensure that they don't waste money on unnecessary procedures.

"You hire managers to find out what doctors and patients are doing and to get them to stop doing it," said Dr. David Himmelstein, an advocate of the government-run, Canadian-style plan, and a researcher on health paperwork.

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