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Health Reform May Hurt Some Firms, Doctors

But the Clinton task force's plan may help the whole economy, if it controls soaring costs

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THE transformation that the Clinton administration is considering for the health care system will create winners and losers across a landscape that fills a seventh of the United States economy.

The goal of the administration's task force on health care policy, chaired by Hillary Rodham Clinton, is to reduce the soaring costs of health care before they bury the economy as well as the federal budget. The task force also wants to provide coverage to 37 million underinsured or uninsured Americans.

To accomplish those goals, Mrs. Clinton's group is looking at three possible plans: employer mandates, managed competition, and direct cost controls.

At the task force's first public hearing March 29, small businesses emerged as the most vociferous opponents of mandates, because most of the nation's uninsured people are employed in businesses with less than 25 workers.

Small businesses have to pay far more than large corporations for health insurance, because they lack the bargaining power and administrative efficiency of big companies. Many are also operating closer to the margin of profitability.

If health-insurance mandates are imposed, many small-business employees will get coverage, but others risk layoffs or having to bear a high cost of insurance. The employers risk bankruptcy, industry representatives told the health-reform task force.

Of the 20 million people who work in the retail industry, a half million would lose their jobs in the first year of employer mandates, said Tracy Mullin, chief lobbyist of the National Retail Federation.

But not all businesses see mandates as a losing proposition. Private insurers currently pay increased costs as hospitals and physicians pass along their bills for treating the uninsured. If there are fewer uninsured, then those costs will be lower. Some doctors oppose plan

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