16. Using payroll taxes is also somewhat progressive, because although health expenses can be expected to be roughly equal for each person, people with higher incomes from work pay higher payroll taxes.

  

17. For an example, see Mathews (2005), who describes how Kaiser Permanente reviews clinical trials and provides guidance to its practitioners.

  

18. A study by RAND predicted that, if implemented effectively, fully operational health information technology systems could reduce U.S. health spending by as much as $77 billion annually (Hillestad et al., 2005). However, the RAND study came under criticism by the Congressional Budget Office (2008c) and others for using overly optimistic assumptions.

  

19. Food taxes are less straightforward to implement than cigarette and alcohol taxes because food is a necessity, there are few externalities associated with overeating (compared to, for example, drunk driving), and even healthy people at low risk for obesity-related problems consume junk food on occasion. A federal excise tax of 3 cents per 12 ounces of “sugar sweetened” beverages (which include a variety of carbonated and noncarbonated drinks) would generate $50.4 billion in additional revenue over the next decade (Congressional Budget Office, 2008b).

  

20. A comparative effectiveness research center in the United Kingdom has not produced significant savings, and some have argued it has increased spending by giving a “stamp of approval” to expensive but cost-effective treatments (Pearson and Littlejohns, 2007).



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