Lewis Mehl-Madrona: Single Payer Health In this article, I look at possible difficulties of implementing single payer health care in the United States. We review studies that show that the difference in health care costs between the U.S. and Canada are due almost entirely to administrative costs. We look at the administrative inefficiencies that already exist in the U.S. and amply them to start a single-payer system, supporting local control of health care.