ROBERT SIEGEL, host:

From NPR News, this is All Things Considered. I'm Robert Siegel. Reforming the nation's health care system is a priority for President-elect Barack Obama. The elements seem to be in place for change - Mr. Obama's interests, big Democratic majorities in Congress, a crumbling health system, and a public call for action. But as NPR's Julie Rovner reports, one of the biggest changes to a single-payer system still gets a cool reception.

JULIE ROVNER: David Himmelstein is frustrated. A doctor and professor at Harvard Medical School, he co-founded Physicians for a National Health Program more than two decades ago. The group's goal is to promote the adoption of a single-payer health care system in the U.S. The concept is straightforward. Doctors, hospitals and other health-care facilities stay private, but the bills are paid by the government and funded by tax dollars. Himmelstein says it's the only health system fix that makes sense, particularly now.

Dr. DAVID HIMMELSTEIN (Medicine, Harvard Medical School; Co-founder, Physicians for a National Health Program): The economy bottoming out is really making the other alternatives that are on the table not viable options, so they may make political sense, but they're economically nonsensical. So, we think that the country actually is requiring a movement towards single-payer.

ROVNER: But those in charge of health care in Washington don't see it that way. Senate Finance Committee Chairman Max Baucus recently unveiled his own hundred-page white paper for a health overhaul. He says he doesn't see single-payer as a viable option.

Senator MAX BAUCUS (Democrat, Montana; Finance Committee Chairman): I don't think a single-payer system makes sense in this country. And we are America. We will come up our uniquely American solution, which will be a combination of public and private coverage and public and private provisions.

ROVNER: In the House, California Democrat Pete Stark, who chairs the key Health Subcommittee, has proposed his own version of single-payer, but even he says the public is simply not ready for the huge change that eliminating private health insurance would involve.

Representative PETE STARK (Democrat, California; Chairman, Health Subcommittee): We may get there over time, but I don't think, with something as personal and important as medical care, people are ready to give up what they have, or what they think they have, and just walk away from it.

ROVNER: That attitude irritates single-payer backers like David Himmelstein, who says public support for a government funded system is broader than those inside the beltway realize.

Dr. HIMMELSTEIN: If you ask the American people - an ABC News/Washington Post poll has done that and CNN has done that - the majority of American people say they favor a program like Medicare, paid for out of taxes, covering all Americans. That's a description of single-payer.

ROVNER: A lot of people do tell pollsters they would favor a single-payer system to help cover the uninsured and control costs. But that's hardly the whole story, says Bob Blendon. He's an expert in health-care public opinion at the Harvard School of Public Health. The real issue he says is...

Dr. ROBERT BLENDON (Health Policy and Political Analysis, Harvard School of Public Health): What you have is that there are a lot of ways to do this and the others get more support than single-payer.

ROVNER: For example, in September, a poll offered voters seven different options for boosting heath coverage, ranging from giving employers incentives to offer their workers insurance to expanding existing programs like Medicaid for the poor. And while single-payer has won big majorities in many polls, in this one, it came in dead last.

Dr. BLENDON: That really deals with the fact that I have a poll, let's say, that has 52 percent. You're right, but the other plan has 70 percent. And so, when you really rank them, it is the least popular option the president could chose.

ROVNER: Another problem is the fact that while supporters of single-payer are very committed, opponents feel just as strongly that a fully government funded health system would ruin all that's good about U.S. health care. Blendon says that's a key reason why no president since Harry Truman has proposed a single-payer plan.

Dr. BLENDON: That all has to do with the sense of controversy they felt they would face if they did that.

ROVNER: President-elect Barack Obama said at a town hall in August, taped by CNN, that he would support a single-payer system, but only if he was building a new system from scratch.

(Soundbite of President-elect Barack Obama town hall speech, August 2008)

President-elect BARACK OBAMA: A lot of people work for insurance companies, a lot of people work for HMOs. You've got a whole system of institutions that have been set up. Making that transition in a rapid way, I think, would be very difficult.

ROVNER: Making him just the latest president who probably won't be offering up a single-payer national health plan. Julie Rovner, NPR News, Washington.

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