Polls show that health care is a major issue – rivaled only by the Iraq war – in the current presidential campaign. Complaints about the present system include the mounting cost, the many left out, poor service and too much paperwork. Yet all the major candidates of both parties advocate only makeshift modifications of a system widely viewed as broken.

Republican candidates insist on keeping health care “market based,” which sounds great but has left some 47 million Americans uninsured and produces exorbitant salaries, huge advertising campaigns and enormous political contributions from the insurance and drug industries. They stoke the widespread fear of “socialized medicine” fostered by generations of propaganda.

Most Democratic candidates do the same, though without saying so, and stick to the accidental and failing linkage of health care and employment. That connection began in World War II, when employers dodged wage caps by offering health benefits instead of pay raises, and has hung on ever since. Now large as well as small businesses are finding health benefits an unsupportable burden. Only Dennis Kucinich, Mike Gravel and Bill Richardson dare to favor an active role by the federal government, and they probably have no chance of getting the nomination.

So whoever the nominees are, the presidential race looks certain to avoid any consideration of a fundamental change in the present American health care system, which costs twice per capita what is paid by virtually all other developed nations, while the United States rates 37th in overall performance according to the World Health Organization and has the highest infant mortality rate and highest prescription drug costs in the industrialized world.

Two Harvard professors, co-founders of Physicians for a National Health Program, advocated a “single payer” health plan for the United States, in the Dec. 15 New York Times. David U. Himmelstein and Steffie Woolhandler wrote that the various efforts to reduce the number of uninsured were all little different from a 1971 plan by President Nixon and did little or nothing to reduce the number of uninsured. They write that only a single-payer plan could cut costs substantially and estimated the savings at $350 billion.

But the major candidates seem put off by faulty arguments such as that the Canadian plan is disliked by some doctors and involves long wait times for elective surgery. Yet polls show that most Canadians prefer their plan to ours. And wait times, which don’t interfere with emergency medicine, could be rectified by better financing.

Much of American health care is already run quite satisfactorily on a single-payer basis: Medicare, Medicaid and the veterans’ health system.

Government-run health plans, usually single-payer plans, are good enough for Canada, Britain, France, Denmark, Sweden, Germany, Australia, New Zealand and most other developed countries. Why can’t they even be considered and debated by candidates for the U.S. presidency?

If both parties continue to avoid even mentioning a single-payer plan, Election Day could see ballots marked “none of the above.”