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.


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.

Indeed, he predicted that by moving Medicaid patients into a higher-overhead private insurance system, extending coverage to the 37 million now uninsured and setting up a nationwide network of insurance-buying cooperatives, the government would probably add $15 billion to $20 billion annually to administrative costs.

During an appearance at a neighborhood health clinic in downtown Minneapolis, Mrs. Clinton sat surrounded by tall stacks of files and forms as she listened to a nurse, Mary Linden, describe how she spends nearly all her time helping low-income mothers-to-be complete the paperwork required for Medicaid and other types of insurance.

The bureaucratic delays are so long and the task so daunting--especially for those with low levels of education or poor English skills--that early prenatal care is effectively lost to women who are not insured through their employers, Linden said.


“We have to simplify the system” and eliminate “the paperwork jungle that has beset our health care system,” Mrs. Clinton later told a health care conference at the University of Minnesota.

“In the last 15 years, hospitals on average have hired four administrative and clerical employees for every doctor,” Mrs. Clinton said. “We have turned nurses who went to nursing school to care for patients into bookkeepers. We have watched as we have tangled our hospital administrators and those who work in our hospitals in a web of paperwork that bears no relationship to the care that you and I expect when we walk in the door.”

Mrs. Clinton took the Administration’s health care road show to Minnesota because of that state’s pioneering efforts to implement universal health care through reforms that she said had served as a model for many of the proposals embraced by her health care task force.

MinnesotaCare, adopted in 1992, now provides subsidized health insurance on a sliding fee scale to low-income working families with children through a 2% gross revenue tax on hospitals and other health care providers and a 5-cent increase in the tax on a pack of cigarettes.


Mrs. Clinton lauded Minnesota’s efforts as far ahead of most other states, but she reiterated the Administration’s opposition to the single-payer, Canadian-model health care system that many Minnesota health care experts favor because of the new taxes and the federal bureaucracy that would be involved in administering it.

“What we would rather do is build on the system we already have, an employer-employee system” that “allows us to achieve reform without compromising our . . . principles” of health care reform, Mrs. Clinton said.

But, in a gesture to Republicans--whose support will be essential to the passage of any health care reform--she added that the “answers are not coming down in tablet form” and “there is a great opportunity to work in a bipartisan fashion . . . to come up with better ways to achieve these principles than our process has produced.”

Times staff writer Michael Ross in Minneapolis contributed to this story.