The dilemma is a classic for all news organizations covering government or elections.
The news media doesn't cover a proposal or political candidate because the media doesn't think either has a chance of success. But without news coverage, how will either get enough attention to make a difference?
In this case, it's the single-payer approach to the current national debate over paying for health care.
More than 300 listeners have complained that NPR is ignoring the single-payer movement in covering Congress's overhaul of health care. NPR says it's just being practical.
A single-payer medical system would be similar to a broadened Medicare, with doctors, hospitals and health-care facilities run privately but the government paying the bills with taxpayer money.
Supporters consider it the best solution to a crumbling health care system. Often they cite polls indicating broad public support. For example, an April 2009 CBS/New York Times poll said 57 percent of respondents were "willing to pay higher taxes so that all Americans have health insurance."
"The majority of Americans want single payer," wrote Selma Goldberg of Crofton, MD. "It is the health care of choice for almost all other industrialized nations. There is no question it is superior in every way to alternatives. Why are you opting to exclude coverage of this system? I am unhappy with the way you cover the news, bowing as you do to commercial interests."
But here's the reality. NPR says it is not avoiding coverage because it is beholden to the health insurers or big Pharma — as claimed by an "NPR Watch" piece for Counterpunch, a political newsletter.
"Revenue in the pharmaceutical category represents only 3 percent of total underwriting revenue," said John King, operations manager for NPR Sponsorship.
The decision not to devote a lot of attention to single-payer, I'm told, is based on pragmatism.
"This issue is not getting a lot of attention from NPR because it's simply not on the table in Congress," said Julie Rovner, NPR's lead reporter covering the health care overhaul. "I think the reason that single-payer is not on the table is because it's too big a change."
There are two major bills in the House and Senate to provide health care to all Americans. H.R. 676, introduced by Rep. John Conyers (D-MI) has 85 co-sponsors and endorsements from 550 labor organizations, according to the Thomas database for the Library of Congress. Senate bill S. 703 introduced by Sen. Bernie Sanders (I-VT) has no co-sponsors. The California state legislature twice passed a single-payer bill. Gov. Arnold Schwarzenegger vetoed both.
NPR's most recent story solely on single-payer was Dec. 24, 2008 on All Things Considered. It explored the political prospects (not good) for a single-payer system. Last summer, NPR did a series that explored national health plans (each with similarities to a single-payer system) in France, Germany, Great Britain, The Netherlands and Switzerland.
Since late February, the single-payer approach has been mentioned or discussed in broader health care stories at least 25 times. All NPR healthcare stories are aggregated here. On July 8, Talk of the Nation, looked at the politics behind health care for 20 minutes and single-payer was discussed.
"NPR's coverage is not much different than other media in that it tends to dismiss the single-payer alternative as a marginal phenomenon and discount it as a legitimate solution to the health care crisis," said Mark Almberg, communications director for Physicians for a National Health Program, a 16,000-member group supporting the concept. "Such discounting excludes us from the political process."
Rovner said that 160 million Americans now get employer-provided health insurance. "There are enough people who are satisfied with what they have now and it would be too big a shock to do such a massive change," she said. "All the experts I talk to say this doesn't have a chance because it would mean getting rid of employer-provided insurance."
She pointed out that "most polls that offer a wide range of choices show that a good 30 percent of the public is for single-payer."
"The problem is it's not a majority," Rovner said. "I feel like I'm one of the few reporters that has recognized from the beginning that the single-payer supporters are an important element in this debate." Rovner is one of the most experienced and widely respected reporters covering health care policy in the U.S.
One reality for NPR is that there are dozens of aspects of the health care debate to cover.
"We are giving single-payer as much attention as it needs given the discussion in the nation's capital about overhauling health care," said Anne Gudenkauf, who heads the science desk. "We need to give them [the listeners] information about what's on the table. Not what's not."
Rovner did several news spots in May for newscasts when single-payer advocates, upset they weren't invited to testify, disrupted several health care hearings. Thirteen were arrested at one.
"We haven't done a stand-alone single payer story since last year, but as you'll note in the sheaf of stories I handed you," said Rovner, "I have gone out of my way to include the single-payer viewpoint in nearly a dozen stories I've done this year. I think that's far more than most of the mainstream media can claim."
Rovner's correct about including single-payer views. But I think NPR could have done a few stories directly on the single-payer concept — especially because by Rovner's own statement, polls show 30 percent of the public supports it.
Shortly before posting this, Rovner stopped by to say that she intends to do a piece next week on single-payer and another long-shot health care proposal that are both noteworthy but won't pass because they would eliminate employer-provided health insurance. She said it's been on her list of stories to do for weeks.