complexity of our current reimbursement schemes requires providers to fight with insurers for payment for every aspirin and bandaid. This requires a huge administrative staff, billing computers etc. In contrast, a single payer system could greatly streamline providers' paperwork. Paying hospitals on a lump sum budget basis -- e.g. as a fire department is currently paid -- could cut hospital administration costs in half. Similar savings could be realized by simplifying doctors' billing. When Canada adopted single payer, did she allow labor unions to opt-out and "keep what they have." No. Neither the provinces nor the federal government ever allowed labor unions to opt-out of the plan. Confusion on this point seems to arise from two places. 1) The province of Alberta did not join the single payer system until 1968, and 2) from the beginning, for non-covered benefits only, unions and individuals could "keep what they had" and could bargain for supplementary health benefits with private insurance companies. In 2008, less than 8 percent of U. S. seniors chose family medicine, a 50 percent decline since 1997; only 199 U. S, seniors matched into primary care internal medicine, 248 into IM /Peds, and 53 into primary Peds. The percentage of international medical graduates (IMG's) in our 3 primary care specialties is now 73 percent for IM, 68 percent for Peds, and 55 percent for Fam. Med. (Pugno, P , et al Fam Med 40 (8): 563, 2008) I don't believe that we have more than about 30 percent of