An estimated 26.4 million Medicare clients received flu shots in the 2009-10 flu season. Allowing $2.00 per person for administration (one-tenth of what it now spends), Medicare could have sent every one of those enrollees a $20 gift card for a flu shot at Doctors Express and saved taxpayers about a quarter of a billion dollars.
A billion here, a billion there, and pretty soon freeing patients and providers from third party payment systems would add up to real money.