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MADELEINE BRAND, host:

From NPR News this is ALL THINGS CONSIDERED. I'm Madeleine Brand at NPR West.

ROBERT SIEGEL, host:

And I'm Robert Siegel in Washington.

As lawmakers wrestle with fixing the nation's health care system, some ideas are not getting a serious look. We hear complaints that market-driven proposals designed to make patients better shoppers for health care are not being adopted - more on that coming up.

First though, NPR's Scott Horsley reports on an idea from the left that has been all but ignored.

SCOTT HORSLEY: Just about every time President Obama holds a town hall meeting, someone asks a question like this one from Linda Allison in Rio Rancho, New Mexico.

Ms. LINDA ALLISON: I talk to a lot of people about health care. My question is why have they taken single-payer off the plate?

(Soundbite of cheering)

President BARACK OBAMA: Got the little single-payer advocates up here.

(Soundbite of cheering and applause)

Pres. OBAMA: All right.

HORSLEY: Mr. Obama takes a moment to explain single-payer, which is about all it takes because it's pretty simple: You go to the doctor or the hospital and the government pays - no insurance middleman, hardly any administrative costs. The government pays, like Medicare, only you wouldn't have to be 65 to qualify.

Then, the president offers what's become his stock answer to the single-payer supporters.

Pres. OBAMA: If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense. That's the kind of system that you have in most industrialized countries around the world. The only problem is that we're not starting from scratch.

HORSLEY: Mr. Obama argues that shifting to a single-payer system would be too disruptive to an industry that makes up one-sixth of the U.S. economy. That view is shared by most of the policymakers now running the health care debate, but not by Ohio Congressman Dennis Kucinich.

Representative DENNIS KUCINICH (Democrat, Ohio): We're not starting from scratch. We're starting in a ditch. And the ditch is that Americans are being driven into poverty by a health care system that is for-profit.

HORSLEY: Kucinich made single-payer health care a cornerstone of his own quixotic presidential campaign.

Rep. KUCINICH: One out of every $3 in our current health care system goes for corporate profits, stock options, executive salaries, advertising, marketing, the cost of paperwork. If you took the money that is being wasted and put it into a not-for-profit system, you'd suddenly have enough money to cover every American, all paid for.

HORSLEY: Health care expert Peter Harbage agrees a single-payer system would eliminate a lot of unnecessary costs, but those costs all have their defenders on Capitol Hill. And Harbage, who's with the Obama-friendly think-tank, the Center for American Progress, says policymakers chose to patch the existing system, rather than tear it down and start over.

Dr. PETER HARBAGE (Fellow, Center for American Progress): We have a system in place that's based on private insurance. And what I think we see in health reform is an effort to build on what works and fix what doesn't.

HORSLEY: Harbage says single-payer never really had any traction.

Dr. HARBAGE: The idea that single-payer was affirmatively taken off the table, it just really never was put on the table. It was never discussed as fully as we see some of these other ideas being discussed now.

HORSLEY: Senate Finance Committee Chairman Max Baucus admitted to the New York Times last month it may have been a mistake to rule out single-payer, if only because having it on the table would have made the president's public insurance option seem moderate by comparison.

Congressman Kucinich points to public opinion polls showing broad support for single-payer. He did get a foot in the door last week, when a House committee agreed to give states the option of pursuing single-payer health care on their own.

Rep. KUCINICH: Sooner or later, some state is going to break through in a major way with a single-payer initiative. The Kucinich amendment at least gives states the hope that some state can break through to be a model for other states.

HORSLEY: But that means a state would have to be willing to do what the federal government would not and start from scratch.

Scott Horsley, NPR News, Washington.

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