101. Even though the direct costs of malpractice disputes amounts to a sum lower than one percent of the $541 billion the nation spent on health care last year, doctors say fear of lawsuits plays a major role in health-care inflation.

(A) amounts to a sum lower

(B) amounts to less

(C) amounted to less

(D) amounted to lower

(E) amounted to a lower sum

这里say是什么成分呢？是doctors的谓语吗？如果是，为什么后面的宾语从句不用that；如果不是，它又是什么成分呢？doctors say fear of lawsuits plays a major role in health-care inflation.这句话如何翻译？

多谢！