or up if Medicare were expanded to cover everyone. Most economists agree that such expenses should not be included in calculating Medicare's overhead. How much could the states save on administrative waste by adopting a statewide single-payer program? Estimates of state administrative costs (a few years old, but the best available) are in an article by Drs. David Himmelstein and Steffie Woolhandler from 2003. What will happen to malpractice costs under national health insurance? They will fall dramatically, for several reasons. First, about half of all malpractice awards go to pay present and future medical costs (e.g. for infants born with serious disabilities). Single payer national health insurance will eliminate the need for these awards. Second, many claims arise from a lack of communication between doctor and patient (e.g. in the Emergency Department). Miscommunication/mistakes are heightened under the present system because physicians don't have continuity with their patients (to know their prior medical history, establish therapeutic trust, etc) and patients aren't allowed to choose and keep the doctors and other caregivers they know and trust (due to insurance arrangements). Single payer improves quality in many ways, but in particular by facilitating long-term, continuous relationships with caregivers. For details on how single payer can improve the quality of health care, see " A Better Quality Alternative: Single Payer National Health Insurance. " For these and other reasons, malpractice costs in three nations with single payer are much lower than in the United States, and we would expect them to fall dramatically