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Of course. If you're dealing with 40 different private insurers instead of a single-payer, admin costs are going to be much higher.

Exactly, one of the advantages by definition of "single-payer" is lower admin costs. Germany has a two tier system where the majority of people are on the public system while the more fortunate few are "Privat". The cost of "Privat" is horrendously*** high while the quality of the public system was described by one of my neighbours using terms mentioning dungeons, shelves of spider webs, bone saws, going back 300 years ... she grew up Privat but when she married ended up on the public system.

*** - When I first started working for NATO we split the DM 2800 a month with me paying 1/3rd and employer paying 2/3rds.

A young man acquaintance of ours on public system had a knee injury treated in the doctor’s office, ended up with flesh eating disease that came close to putting him out of his misery. Not long after he had a collapsed lung that was related(?) to the flesh eating disease in his leg, thought he was gone. A US military doctor who did my exit (from the military) medical told me if I couldn't get a Canadian or American doc to work on me that I should crawl across the border into Holland!

Should add to beware of German Dentists, they look for ways to fill your mouth full of metal contraptions at very high cost.

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