Costs of Health Care Administration in the United States and Canada

To the Editor: There is little doubt that per capita health care administrative costs are lower in Canada than in the United States, as Woolhandler et al. report (Aug. 21 issue), 1 even though the precise magnitude of the gap is open to debate, a point that Aaron makes in his accompanying editorial. 2 However, the Canadian single-payer system results in chronic shortages of medical services because of underfunding. The underfunding problem is usually considered to be a separate issue from the single-payer system itself, 2 but the very structure of the single-payer system may cause the problem. In the United States, persons . . .