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View Diary: The lost conservative (really) (74 comments)

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  •  You and I are, perhaps, not too far apart (5+ / 0-)

    I call myself "conservative" but always in quotes because I want to differentiate myself from what passes for conservatism in the Republican party.  I also identify as a skeptical conservative or, as Andrew Sullivan often says, a conservative of doubt.

    A good example of this is a topic that you bring up which is single-payer health care.  I had been skeptical that putting the government in charge of the healthcare system would be a good thing.  After all who wants a healthcare system with the efficiency of the USPS, the compassion of the IRS or the wait times of the DMV (or so the conservative framing goes).

    But as I studied the debate a bit more, what we were talking about is the funding mechanism and not the healthcare system as a whole.  Thus, with the government in charge of healthcare you wouldn't have doctor's and nurses be government employees.

    Anyway, while I was still skeptical, I examined my values and thought that the most important aspects of a healthcare system were universal access, outcomes of the care and the cost of the system.  When viewed through that lens what comes through is that single payer throughout the world creates universal access, has outcomes as good, if not better than ours, and its costs are significantly below ours.

    Thus, while I was skeptical, I have come to strongly lean toward the belief that single payer can be justified on conservative grounds simply because it seems to be the best and most efficient model out there.

    We cannot solve our problems with the same thinking we used when we created them. Albert Einstein

    by theotherside on Thu Mar 21, 2013 at 07:56:15 AM PDT

    [ Parent ]

    •  Another angle on single payor (3+ / 0-)
      Recommended by:
      amyzex, DrPlacebo, newinfluence

      When people question it on the basis of "government in charge," they imply the rest in something that rhetoricians call an argumentum ad populis, or an argument by the prejudices of the audience. It's a dirty trick because the speaker never actually has to prove the proposition or support it with data or even specifically charge one thing or another.

      However, for those who do wish to analyze health care solely along the lines of expense, the analysis is only half complete if one says, "The government wastes money."

      Suppose that all government institutions alike waste, could we guess at an amount lost to waste? 15% is the highest number ever accused of being waste in Medicare, I believe, and that was decades ago. So, we can take 15%, accept it, and say that it not only did occur but that it must occur.

      Now for the other half of the analysis: Private insurance and private medical providers make a profit.

      How much is the profit margin, all told? If we took a broken arm from start to finish, how much would the various agents' profits be in the overall cost? Would it be 15% or more? (Hint: it's much, much, much more.)

      Next, if we wish to limit waste or profits, what can we do? If we have government health care, we have the power of the ballot box. If we have five or seven health insurance giants that force all clients to sign arbitration-only agreements, we have no power at all, unless a state regulates.

      In other words, the moment we strip prejudice and assumptions out and ask even about "cost" on all sides, the traditional "liberal" approach of prevention over punishment is best.

      Everyone is innocent of some crime.

      by The Geogre on Thu Mar 21, 2013 at 12:06:28 PM PDT

      [ Parent ]

    •  I think our positions are (1+ / 0-)
      Recommended by:
      The Geogre

      subtly different. Mine is that single payer is the proven solution, shown to work over decades in dozens of countries with all different types of economies, while the employer-based system we have is empirically a failure.

      I think where we are alike, and where we differ from the Republicans, is recognizing that we have a problem. I'm all for problem-solving; it's just that, for me, proven solutions take priority over experiments. In that, I am perfectly OK with looking abroad for evidence, especially when the evidence from other countries weighs overwhelmingly in one direction.

      •  I would say that fits my general view as well. (1+ / 0-)
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        I would say, in broad generalities, that if liberals see a problem they think about how the problem could be solved and would want to see it role out to the whole country.  Reactionary republicans don't really even look for problems and would be against any federal government action.

        As a conservative, I'm hesitant to go the federal route.  Show me how it worked in various different states.  Show me why one program worked in one state and why another state had slightly different results.  How did the actual costs of the program match up with the estimated costs of the programs?

        Give me that data and a reasonable debate and I'll try to make an informed decision about whether that program should be funded by the federal government.

        On single payer, we don't have successful state examples but the success of other nations with that system lead me to support single payer (devils will be in the details though.)

        Have you seen any good debates/arguments concerning the difficulty of a large country like the US implementing single payer?  A conservative friend of mine recently made the argument that it is far easier for France, Japan or the UK to develop a single payer.  I'm not sure why it would be much harder than a small country but I haven't really been exposed to the arguments on either side.

        We cannot solve our problems with the same thinking we used when we created them. Albert Einstein

        by theotherside on Fri Mar 22, 2013 at 06:15:43 AM PDT

        [ Parent ]

        •  Actually, I'd argue the opposite. (1+ / 0-)
          Recommended by:
          The Geogre

          First of all, I want to note that we often underestimate just how big Japan is in terms of human logistics. It may be geographically small, but it has more than half of our population.

          But more importantly, the whole purpose of single-payer health care is to get economies of scale. A larger country is typically able to negotiate better drug prices with manufacturers, for example. And the risk pool is larger; costs averaged out over more people become far more predictable. There's one further benefit to a large risk pool: consider the the medical costs of a natural disaster in a limited geographic area. The same event that could overwhelm a state-run health care system might not even make a big dent in the budget of a federal system.

          We do in fact have an example that demonstrates the benefits of scale: Canada. Canadian single-payer health care didn't come all at once. It was introduced by provincial legislatures, province by province; that's much like what Vermont has set in motion and what California, Pennsylvania, and New York are all trying to do. But Canadian single-payer health care didn't achieve its full benefit until the national government took it over from the provinces. By that time all or almost all of the provinces had implemented single payer.

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