ARI SHAPIRO, HOST:
Part of that revolution is the idea that the government should provide health insurance for everyone. The so-called single-payer model is used in other countries like Canada and South Korea. But policy makers in this country have never given it a serious look. NPR's Scott Horsley looks at why.
SCOTT HORSLEY, BYLINE: Bernie Sanders make a simple argument for overhauling the health care system. The United States spends more than twice as much as other countries do on health care, but Americans aren't any healthier. And tens of millions of people here have no health insurance.
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BERNIE SANDERS: Our vision must be to guarantee health care to all people in a cost-effective way. And that, to me, means a Medicare-for-all single-payer program.
HORSLEY: Advocates claim a single-payer system would do a couple of things to lower the cost of health care. With just one bill-payer covering everyone, it would dramatically streamline paperwork. Gerard Anderson of Johns Hopkins says health care administrative costs here are two to three times what they are elsewhere.
GERARD ANDERSON: We're paying quite a high amount for having a lot of choice among different health insurance systems. So Americans like choice; we just have to pay for it.
HORSLEY: Needless paperwork is only part of what's keeping health costs high. Anderson says the most important factor in America's costly medical bill is prices.
ANDERSON: If you got to the hospital, you're going to pay a lot more. You go to a doctor, you're going to pay a lot more. You buy a prescription drug, you're going to pay a lot more. And it's because we don't have anybody negotiating the prices as one entity as they do in Canada or they do in the U.K.
HORSLEY: Backers say a single payer would have the bargaining power needed to force doctors, hospitals and drugs companies to accept lower prices. Advocates tried to make that case in the early days of the Obama administration, though single-payer was never really part of the conversation.
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UNIDENTIFIED WOMAN: My question is, why have they taken single-payer off the plate?
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BARACK OBAMA: We got the little single-payer advocates up here.
HORSLEY: President Obama told this town hall audience back in 2009 single-payer might make sense if the U.S. were starting from scratch, but it's not. Obama was leery of causing too much disruption to one-sixth of the U.S. economy, and Hillary Clinton makes much the same argument today.
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HILLARY CLINTON: I'm not interested in ideas that sound good on paper but will never make it in the real world.
HORSLEY: Harold Pollack of the University of Chicago says, while it's easy to imagine an idealized single-payer system, it's harder to sketch out the roadmap that would take the U.S. from here to there.
HAROLD POLLACK: You cannot close down the American health care system on a Friday and say we're going to open it on Monday as a single-payer system.
HORSLEY: Ongoing opposition to the Affordable Care Act shows just how resistant Americans are to tinkering with their health care. What's more, Anderson says, the government doesn't have a great track record of pushing cost containment.
ANDERSON: Any time we've tried to negotiate prices, what you basically see is, oh, we want to negotiate with hospitals, except for that one hospital in my district that really deserves the money.
HORSLEY: Multiply that by 535 lawmakers and a powerful army of lobbyists. There are a lot of jobs riding on our $3 trillion health care system, and Pollack says the doctors, insurers and drug companies aren't likely to take a pay cut quietly.
POLLACK: That's going to be a knife fight. That doesn't mean that we shouldn't do that, but it's a very, very big challenge.
HORSLEY: Even so, Pollack sees the argument over single-payer as a healthy debate, one we didn't have back in 2009. Former Sen. Max Baucus says, in hindsight, Democrats might have been wise to keep single-payer on the table, if only as a bargaining chip. It would have made Obama's push for a public insurance option look moderate by comparison. Scott Horsley, NPR News, Washington.