I think JV means administrative costs. Medicare and Medicaid administrative costs are far lower than private insurers. But the US system is pretty much proof positive that private healthcare costs more than public, when comparing the same service. Of course, quality of service is another issue. It seems private does better on the high-end care, and public does better on the low-end care. Which makes sense, when you are billing for profit, the high-profit margin care is where you are going to focus your energies. Low-end care is generalized and repetitive, which is just perfect for a public service that can buy in bulk, and seeks parity on costs and expenses. It makes me wonder if you couldn't have plans that created a hybrid of public care for outpatient medicine, and private care for inpatient care where competition and quality makes a difference. General care is dealt with in a very inefficient manner by private insurers, and there's not much money in it.