and so conservatives will have to spend some time relying on charismatic leaders (like John McCain) who can leverage personal popularity into some sort of national relevance.

I'm sorry. What? John McCain charismatic? Does. Not. Compute. Don't confuse his accidental nomination in the face of even worse primary competition with a big help from Republican winner-takes-all delegate allocation rules with charisma.

But the market -- it will solve everything. And tax cuts.

This is a great post, and an illuminating way to think about political parties, their ideologies, and their popularity.

It's sort of the passive voice version of the narrative that the Democrats lost touch in the 60's because they had achieved most of their policy goals from the New Deal generation. Similarly, from 1980-2008, the GOP has achieved most of the goals the party had when Reagan took power, and so they're left without a compelling platform.

Conservative have answers, but the current Republicans are not all that conservative.

But the market -- it will solve everything. And tax cuts.

If we had a market of mortgages without gov't subsidies that guarantees loans for social reasons.
If we had a market of health insurance where gov't didn't exclude out of state companies from competing.
If we had a market for oil where the gov't didn't severely restrict exploration such as the coastal shelves and Alaska.
If we had a market where the need for more refineries could be met and not make impossible through heavy government regulations that have made that impossible.

Now, you may agree that these regulations and gov't interventions are necessary and worth the consequences, but make no mistake, the markets are not free to solve these problems and these issues are the result.

If you wish to criticize the "market", then find a real "market" to criticize.

Ezra, every time you cite that 47 million number you lose a little bit of credibility. If you want to make a point about the need for health care reform then make one without citing that meaningless and very misleading number.

"Conservative have answers, but the current Republicans are not all that conservative."

Sure. Also, real communism was never implemented.

Conservatism cannot fail, it can only be failed.

People are wrong to call modern conservatives fascist. They're just a updated, cornpone version of the Soviets for the 21st century.

They've gone from the "party of ideas" to the "party of idea." No problem exists that can't be solved by a tax cut. Health insurance unaffordable? Tax cut. Obscenely high deficits due to tax cuts? Answer: tax cut. And we're "knee-jerk liberals"?

The problems the GOP is genuinely interested in solving are pretty much confined to those of the rich and the business sector, or beating someone up who they think needs beating up.

So they've got a toolbox that's well-equipped for doing these things. What they've done to succeed electorally is a combination of (a) pretend their tools solve a wider class of problems than they do, (b) convince people that someone's about to attack them and the GOP will beat up the attacker but the Dems won't, and (c) create bogus issues (Wright, Swiftboating, inventing the Internet) and narratives based on those issues, to distract people and keep them from noticing the weaknesses in (a) and (b).

We seem to be at a point where (a) isn't going to fool anyone, and both (b) and (c) are wearing thin.

AB - care to explain why the 47 million figure is meaningless and misleading? It's the official Census datum.

Vaj - "the market" has been meeting the need for more refineries by closing them to reduce competition and increase refinery profits.

- Even if anyone could drill anywhere, there just isn't much more oil to be had in the world. The only question is, how much risk of environmental damage are we willing to endure, in return for a not particularly large or long-lived increase in the world supply of oil?

Even if we could get another few million barrels a day into the production stream, what would happen? The price would go down somewhat, demand would increase, prices would go most of the way back up, and we'd be in nearly the same place.

Who says they ever had any ideas?

With the progressive income tax system that we have (and the scammy idea that the SS tax is not a tax but an investment, and excise taxes being hidden) the majority see themselves as more recipients of government services than paying for those services and so they will demand more services until they see the tax burden slowing growth to so some very low level. They then call for reform/spending reductions.
I see an opportunity for Democrats in that there is so much waste in the government (congress especially republicans in congress are sooo corrupt and the idiot Bushes occupation of Afghanistan and Iraq, plus bloated post USSR military spending) that with smart work they could for a long time deliver more services for less money.

Spot on. This is a party that could have a reasonably coherent philosophy at its core, and by extension some useful policy positions, but has thrown it all away in its zeal for (a) short-term electoral success, and (b) personal gain.

They could propose that taxation be generally low, either as an absolute value or tied to some metric or other. But that would be difficult to explain to voters and would leave money on the table, so they instead insist that taxes are too high no matter where they are and no matter what the economic circumstances.

They could make a case against gay marriage, if not a very good one, if they conceded the fact that some legal framework is desperately needed for gay couples. But that would take away a useful wedge issue for them, so they say no to marriage and propose nothing to solve the problems its absence causes. (Shoot, even if they proposed a constitutional amendment to forbid sodomy and an aggressive enforcement policy, they'd at least be dealing with it in some sense--but they're thankfully not all that batshit insane.)

They could double down on Iraq policy and support a new draft, because we're just not going to win at this rate. But winning is beside the point for them; they just can't be the ones to admit defeat. Too electorally dangerous, even if the policy currently in place is far less sound.

To top everything else off, they're so determined to keep their ranks closed that their scandals look worse and worse. The few recent instances of Democrats behaving badly have been met with universal condmenation on our side--but for every new Fossella, or Craig, or Gonzales, there's fresh evidence that they don't actually care whether people are effective in their jobs. They care about not having to defend an extra seat, or confirm a new appointee.

The Republican party is just not interested in solving problems anymore--it's interested in maintaining as much power as possible. I don't see it coming back until some of its saner members start to look at the gaping hole at its center.

"I'm sorry. What? John McCain charismatic? Does. Not. Compute."

I get the same reaction a lot when I refer to Stalin as charismatic. People tend to think that someone they themselves don't like can't be charismatic, but that's not the case.

APS

I do not like the word "market", I prefer to talk about what people should and should not be allowed to do. E.G. Should I be allowed to contract with an out of state health insuarnce provider? Should I be allowed to sell my stuff at what every price I choose? Should I be allowed to hire my PA brother in law to remove my appendix? etc.

What they're lacking, right now, are the appropriate problems.

You’re absolutely correct about this, but I wouldn’t assume this will necessarily doom them long term electoral. Republicans have never had solutions for anything and they’ve managed to do just fine.

It’s not like Reagan had some brilliant plan to free the hostages in Iran or end the oil crisis. He increased defense spending while the Soviets were looking to end the cold war.

Bush spent the summer before 9-11 thinking of a pretext to ban stem bell research and still he enjoyed tremendous popularity after the attacks. Invading Iraq had no productive value in the fight against terrorism, and he still used that decision to succeed politically in 2004.

low-tech cyclist if I am the owner say 3 refineries should I be allowed to close one in hope that I will get net profit?

They have no ideas because there is no money to pay for anything. We have 130,000 troops in Iraq and will have to borrow money to bring them home.

At the end of the day, they have one, and exactly one idea.

Communism, and by linkage, socialism, (including democratic socialism) is bad..mmmmkay.

EVERYTHING they do, and I do mean everything, is in the pursuit of that point.

I'm becoming more convinced that the conservative problem is not so much a lack of ideas, it's a lack of smart people in the government.

Think about it, if you think that the government is incapable of providing real solutions, then why do you want to be there. The solution is for the smart and capable ones to stay outside the government and get their lackeys to run for office. You can't get rich enough working for the feds, you need your friends to do that while you make the money. What would you rather be, the congressperson or the outside contractor?

Eventually, this comes around and bites you on the ass, and you have to lay low for a time, while the Brownies and Lurita Doans take the fall. And thay count their money.

I think your conclusion may have it backwards -- conservative success isn't about finding solutions for existing problems, but rather about generating perceived problems that can be made to fit their solutions. Want to implement an authoritarian surveillance state? Discover an shadowy global enemy. Want to reduce the growth of socially useful government spending? Discover a threatening country that needs to be invaded. Want to cut taxes? Make up some numbers about the crippling burden on the rich and go right ahead. Want to get people to vote against their economic interests? Discover a bunch of evildoers out to destroy the nation, who look just like you and me, only they have sex differently.

I think Naomi Klein has it just about right in "The Shock Doctrine". Movement conservatism is never up front about its true motives, because at heart they are fundamentally undemocratic.

If they said "Let's get rid of Social Security" only a few rich people would vote for them. Instead they shriek about lowering taxes and invent (black) welfare queens driving Cadillacs.

Movement conservatism needs a stake put through its heart. It is fundamentally dishonest in its approach and never, never should be relied upon to provide any kind of balance. Liberals can rely on sociological studies and the like to see if the enacted programs are successful in treating the problem. We don't need the likes of dishonest hacks to see if a program is working or not.

Movement conservatism feeds on fear and ignorance and has no place is a democratic society. I like the way the (annonymous) quote at the end of Dean's book puts it: Just tell your readers that you have a source who knows a lot about the Republican party from long experience, that he knows all the key movers and shakers, and he has a bit of advice: People should not vote for any Republican, because they're dangerous, dishonest and self-serving. While I once believed that Governor George Wallace had it right, that there was not a dime's worth of difference in the parties; that is not longer true. I have come to realize the Democrats really do care about people who most need help from government; Republicans care most about those who will only get richer because of government help. The government is truly broken, particularly in dealing with national security, and another four years, and heaven forbid not eight years, under the Republicans, and our grandchildren will have to build a new government, because the one we have will be unrecognizable and unworkable."

Ezra,
I think you're right. Conservatism is a set of solutions (tax-cuts, deregulation, invade Communist satellite-states) in search of problems. However, when the problems run out or turn out to need the exact opposite of the pre-ordained solutions, then they run into trouble.
Bush lost in 1992 because Communism was no longer the spectre enabling conservative foreign policy. Dole lost in 1996 because domestic policy favored the Democrats. McCain will lose in 2008 largely because social issues', the winner in 2000 and 2004, has gone the same way.

What the new books on conservative reform share is a desire to take economic anxiety seriously.

This sounds to me a lot like the pleas from writers like Amy Sullivan that Democrats should become more publicly religious in order to win elections. Neither change is likely to happen, and if it did, it would be unlikely to work, because it would be fake. Liberal democrats can't genuinely avow reactionary religious sentiments, because if the did, they would no longer be liberal. Conservative republicans can't genuinely take the economic anxiety of the non-rich seriously because if the did, they wouldn't be conservative.

Ezra, I have to disagree with you that the Regressives have no problems to link to their solutions because fundamentally, their ideas caused the problems! The regressives have been trying since Goldwater to shred the social safety net, or poke hole in it where they could'nt.A Reagan influenced belief in tax cuts to solve any economic malaise, even if there was'nt one is the reason that we are so far behind in our investments in (1)Infrastructure, (2)Education, and (3) Health Care. The median income for a middle wage earner has not risen with the cost of inflation since 1980. Think about that. The cost of living has risen, but your ability to stay ahead of those cost has not. Is there any other reason that we have so many two income-households now (Read Eirenriech's "Two Income Trap".)?Before Reagan, Pell Grants paid for about 90% of a state college education.Now, one would be lucky to graduate withless than $10,000 dollars in loan debt. Before Reagan, we were the world's largest creditor nation. After, the world's largest debtor nation. Before:World's largest importer of raw materials and exporter of finished goods. After:Largest importer of finished goods and exporter of raw materials. Think about these things. There was and is an agenda in them. That being the destuction of the middle class, and return to the Gilded Age. Scratch that, because their agenda is even more insidious.The regressives know that the linchpin of any democracy is a stong middle class, and so, to eliminate democracy you must, by definition, eliminate said middle class.Why do I call these people regressives? Because they would be perfectly happy with a dictatorship or monarchy. "A dictatorship is fine, just so long as I'm the dictator.Heh, heh" George W. Bush.

Sorry, Ezra, I think you blew it with this one, because you totally disregarded the essentially malign nature of the current GOP's "ideas." Read Yglesias' rebuttal: I think he's a lot closer to the truth here than you are.

I wouldn't have said, "taxes will creep up." That's fodder for the Right. I'd have said, "taxes on the rich will creep up." Which is the truth.

low-tech cyclist if I am the owner say 3 refineries should I be allowed to close one in hope that I will get net profit?

I don't know. But if you do, you're gonna look like a real idiot if you whine about how Federal regulations are keeping you from building new refineries.

Clipped this the other day...
It's like you said.

The Future of American Politics, American politics is not a contest of "two equally competing suns, but a sun and a moon. It is within the majority party that the issues of the day are fought out; while the minority party shines in the reflected radiance of the heat thus generated." In 1952, the originator of the notion of realignment, political scientist Samuel Lubell, wrote in his seminal work,...

Just as soon the Republicans
moon about, like...forever.

low-tech cyclist,

The 47 million is a dishonest argument and misleading because it is thrown out as a problem with them not being able to get insurance. i.e. we need to insure the 47 million people who don't have it that want it. Half of those are already eligible for government programs and CHOOSE to not enroll. Another 10 million or so make over 75K a year, can afford insrurance and CHOOSE not to buy it. There are only 3-5 million people that might truly want insurance and can't afford it. Ezra would never use the real number though because advocating scarping our entire HC system of 300+ million majority of whom are satisified per every study done for the sake of less then 1% is stupid. Lucky for Ezra he is preaching to a stupid crowd not well enough enformed to know any better.

AB - care to explain why the 47 million figure is meaningless and misleading? It's the official Census datum.

It is meaningless and misleading because it includes 10 million people who are not US citizens, over 10 million people who were offered employer coverage but declined, and 18 million people who earn over 50K per year. Are there millions of uninsured in the US? Of course. Is the number close to 47 million? No. Ezra is not a dumb guy, and continuing to cite a number that he knows is not really meaningful does nothing but damage his credibility.

Nate beat me to the punch. I used to think Ezra was one of the more rational and intelligent people on the left when it came to discussing health care reform, but lately he seems to be resorting to the same cliched and misleading arguments you hear from the less-informed lefty bloggers. It's rather disappointing actually, because I know he can do better.

So what'll it be Ezra? The party line, or intellectual honesty?

So can we see some real debunking of those numbers?

Hints:

The social problems caused by inadequate health care, including overstressing of emergency and charity services, don't respect citizenship boundaries. You can't wave your passport at multi-drug-resistant TB and claim immunity.

Choosing not to accept employer-based healthcare that you perceive to be unaffordable is not an uncoerced choice.

The social and economic costs of inadequate healthcare are also no respecters of income level (and as S-CHIP has shown, $50K a year can be pretty darn paltry when the price of admission for an unsubsidized family insurance policy is $14K).

One of the things that piss me right off about the self-satisfied "there's no problem, those people are choosing to be uninsured" is the way they gladly accept higher overall economic costs (on behalf of all of us) in the service of some weird principle. Heck, we insist that people who drive cars carry adequate insurance or else face a steep fee, because of the costs an uninsured driver can impose on others. But when someone uninsured declares bankruptcy with unpaid medical bills, that monetary impact just vanishes...

I want to build a refinery next to Floccina's house.

Debunking here:
http://www.nytimes.com/2007/11/04/business/04view.html?ex=1351828800&en=7abf86ba1f3f353d&ei=5124&partner=permalink&exprod=permalink

One of the things that piss me right off about the self-satisfied "there's no problem

No one said there's no problem. What we've said is that exaggerating and miscategorizing the real problem is unhelpful and misleading. There is an uninsured population that needs assistance with paying the cost of health care, but that 47 million number is not at all representative of the true amount, and as someone who follows the health care reform debate very closely Ezra should be well aware of that fact. Continually citing that number is a sign of either ignorance or intellectual dishonesty.

A source for your $14K number? That is not anywhere near the average amount for an subsidized family insurance policy.

Nobody can ever run out of ideas. And conservatives especially because they are not limited by the requirement that their ideas be good ones.

It's more than 50 Million now. An utterly corrupt system...that needs to be 'socialized'.

AB,

What Paul said.

The fact is that 47 million or so people are uninsured. That's just so -- now you can contend that there are reasons why this is so and why it's not a problem for you, but it doesn't make it any less of a fact.

And I can attest that family coverage available through my law firm from Blue Cross Blue Shield in fact costs over $14,000 a year.

So I believe it is you who is either painfully ignorant or intellectually dishonest.

Incidentally, I have spent 20 plus years working with union health plans -- they are cheaper than fully insured products available through BC/BS or CIGNA and the like, but the good ones still cost in excess of $10,000 per year, and that is in an environment where the cost per employee is blended -- i.e., there is no distinction between individual and family coverage.

This is NOT a good post, because it fails to understand that for conservatives, governance is not about coming up with "solutions", "solutions for America", etc. to problems. They simply believe that problems come and go, and many go due to large social forces. That they don't have "solutions" does not mean the same thing as not having ideas -- although they might not have many compelling ones they are putting out right now. For anyone with any sense of history, I would think the word "solution" is not a good one anymore for the political arena.

Ideas are easy; implementation is difficult.

Sir Charles, no one has denied that the 47 million number is a fact. What we've said is that it is a misleading fact, especially given the context in which it is normally used. People love to use that number as evidence of a crisis, i.e. that there are 47 million people who will not be able to obtain the medical care they need because they do not have insurance. This is not at all the case. Is it your contention that the millions people who are eligible for Medicaid but just haven't bothered to sign up are part of our health care problem? How about the people who are not even US citizens?

If we're just going to state facts I've got one for you: elephants have long trunks. That is about as relevant to this discussion as that 47 million number.

What is the employee portion of that $14K? Because Paul's point was that people cannot afford $14K on a $50K income. If an employer is not subsidizing the premium it is foolish to buy the group plan, coverage in the individual market will be far cheaper. The cost shifting and rich benefits that are the norm in the group market drive up premium costs, because people want to have their cake and eat it too with a low premium and low out of pocket costs. We might as well throw in a pony with that while we're at it.

Look at Kaiser's 2007 annual survey, the average employee portion of the premium for family coverage in a group plan is ~$3300. The average total premium is $12K: 85% of companies pay 50% or more of the premium, and 53% pay 75% or more of the premium. The people whose employer pays little to none of the premium would be better served buying an individual plan, and those that wouldn't qualify due to pre-ex are the ones we should be concerned with. The very poor and the very sick need help with health care costs, the rest of us can afford to buy insurance. We should be focusing on the people who truly do need help, but that number is not 47 million, and a significant portion of the 47 million people constantly cited are not members of that group.

It's easy to dismiss these arguments and assume people like me are ignorant (it's funny to think you'd accuse a health actuary of being ignorant) and/or don't care, but you'd be wrong. I'd rather we focus on figuring out the causes of our health care problems and find ways to help those who really need it, not waste our time throwing out big numbers that really don't mean squat.

AB,

1. If you had a single payer health system, the problem of the 47 million uninsured simply disappears.

2. Buying family coverage in the non-group market is not a terribly good proposition due to high costs, pre-existing clauses, etc.

3. Large quantites of employers do not offer insurance or do not pay a significant portion of the premium -- for many people of modest means in high cost areas, this puts the cost of insurance out of reach.

4. The solution to the crisis in health care lays in large part getting rid of a fragmented private system that is deeply inefficient, highly bureaucratic, and riddled with people who extract large sums of money from the system without actually providing care.

The fact that you are a health actuary suggests to me that you know these things, but have a deep vested interest in perpetuating some continuation of the existing model. Interestingly, I have a similar vested interest I guess, but would nonetheless love to see the present system dismantled.

Ron & APS - Oddly enough, I took "charismatic" as tongue-in-cheek humor, and thought it characteristic Ezra humor.

Never occurred to me that it might have been humor.

1. There is no "problem of the 47 million uninsured". 10 million are not citizens and would not be covered under single payer. Millions more are eligible for Medicaid and just need to apply, for all intents and purposes they ARE insured. And of the 18 million making $50K ($10M making $75K+) plus there is a significant number that could afford insurance. There are uninsured people in the US, but the number is an order of magnitude smaller than 47M. We should not change the entire system and take away the coverage that many currently have and are happy with because of that small percentage.

2. I addressed the issue of pre-ex, and the fact that family coverage in the individual market is available much cheaper than the $12K average of group plans. No underwriting, guaranteed issue, rich benefits, and years of cost-shifting have made group premiums very expensive. For many people buying family coverage in the individual market is in fact a very good proposition. A general lack of knowledge about the individual market prevents many from being aware of that fact.

3. Like I said above, the very poor and very sick need help affording health care. The cost of insurance is within reach for most of the others. If they've chosen to spend money on other things instead that is their choice, but we should change the system to accommodate those poor choices.

4. riddled with people who extract large sums of money from the system without actually providing care
Another common health care myth, that the problem lies with insurance companies making a profit and admin costs. So take away all of the profits and admin costs of insurance companies, you reduce the total cost of health insurance by 20% or so. You're still left with double digit annual inflation, so all you've done is delay the inevitable, not avoid it.

The fact that you are a health actuary suggests to me that you know these things, but have a deep vested interest in perpetuating some continuation of the existing model.

This couldn't be any further from the truth, and quite frankly I'm getting sick of hearing it. Is it incomprehensible to people that someone can just disagree on the correct way to fix the problem, rather than them being motivated by pure greed or self-interest? You still need health actuaries in a single payer system, and my skills as an actuary can also be applied to life insurance, P&C insurance, pensions, and various other financial disciplines. I have no "vested interest" other than solving the problem of making top-notch health care available to those who need it in a cost-effective way.

Ron & APS - is it possible that Ezra meant "charismatic" as tongue-in-cheek humor?

"they don't have solutions for 47 million Americans without health insurance. They don't have solutions for a failing invasion that's exposed American power as significantly more constrained that the world imagined it to be. They don't have solutions for high gas prices, or a credit and mortgage crisis, or a dawning recognition that we're ruining the only planet we have."

That is nothing but rhetoric, and it deserves nothing but rhetoric in response, so here goes:

1. Liberals have no solution for the problem of tens of trillions of dollars of unfunded liabilities in Medicare. That is at least as serious a problem as the uninsured.

2. Liberals have no solution for the Iraq war, either. The idea of leaving now and then coming back if things get really bad is an awful gamble. If we do have to come back, we will have lost the confidence of the entire population, whereas now we have gained a lot of it.

3. Liberals don't have a solution for high gas prices, either. Nor should they. High gas prices are the market's warning that oil demand is rising faster than supply, and we need to curb demand.

4. Liberals don't have a solution for the credit or mortgage crisis, either. Everybody is flailing at it, and my guess is that it will be over long before anyone figures out something sensible to do about it.

5. Liberals don't have an explanation for why a dispassionate but scientific literate person should believe in anthropocentric global warming. There ought to be some straightforward evidence that overwhelms the basic fact that carbon dioxide is a tiny fraction of greenhouse gases.

Whoo! Klingon! Since you offer nothing but, by your own admission, "rhetoric" , to what your perception of rhetoric, here's more substantive "rhetoric" in response. 1. Regressives actually don't want to present a solution to what you call the "unfunded liabilities" of Medicare, because, you have always hated the very concept in the first place. When Johnson proposed it, it was the Regressive party primarily that opposed it, because regressives hold the ideology that fundmentally, if for some reason, one cannot solve a medically related problem that they or their family may incur, it's their own damn fault and it's tuff luck for them. 2.Much of the "unfunded" part could be funded with a reduction of our $550 billion dollar defence budget to oh about, $400 billion, with the savings going to those "liabilites". 3.This liberal's idea to the problem of our occupation of Mesopotamia would be to create an Arab NATO, working with the actual NATO, that would patrol a physically segmented (By a wall.)tri-partishioned Mesopotamia that shares the nationalized oil revenue equally. 4.I don't have an immediate solution to high oil prices, but I do believe that once we get the former oil men,junta out of the White house,a new administration that takes oversight seriously (Preferably, Obama.) will lower prices significantly. 5.Not "everyone" is flailing at the subprime crises, because if they were they would get to the root of the problem. That being the repeal and the re-institution of the Glass-Stegall act. If this act which had been in place since 1932 , had not been repealed, thus allowing banks once again to become investment firms, we would'nt be in this mess in the first place.Oh, and it was the regressives that pushed for it, and a corporate Democrat (Clinton) who signed it into law. 6.Liberals don't have to make excuses for the waywardness of idealogues who simply don't want to follow the vast amounts of scientific information that the vast majority of scientist who study the issue of Global Warming, have concluded that the issue is real and undeniable.

AB,

The problems of administrative costs stem not simply the health insurance companies making profits. It is the need for hospitals and doctors to deal with thousands of different health plans and all of the staff and complexity that entails -- it is the need to pay PPOs to provide discounts to self-funded plans -- it is the money extracted by pharmaceutical benefit managers, some of the least transparent entities in America, for their services -- it is the expense associated with the accounting, actuarial and legal services needed by health plans. Thees costs are huge and almost completely unproductive.

A Medicare for all system, with the government using its enormous purchasing power to keep down costs and the elimination of all of these middle men would result in huge savings.

And the notion that Americans are universally happy with their insurance is fatuous -- people have to grapple with coverage issues all the time, whether it is changing or losing jobs, getting laid off, having kids reach certain ages, etc. It's completely unnecessary to have to deal with such nonsense.

Universal cradle to the grave coverage like every other indistrialized nation manages to do and at a fraction of the costs that we endure should be our goal. Why we persist in not learning from the rest of the world is an enduring mystery.

Oh, an Arab Nato! Why has no one else thought of that one. You asshat, such organizations of Arab states have existed in the past. Do you think they "solved" the problems?

Name-calling is the first bastion of those that know that intellectually, they have no argument. Secondly, no ad-hoc coalition of Arab-states that would quell the civil-war in Mesopotamia has been proposed. At least not at a high level that I know of. Third, I would call your mother an asshat for birthing you, but that would be giving her too much credit.

If you want to know why conservatism is dead intellectually and what can be done to restore the ideas of individual rights, limited government, and laissez-faire capitalism, I would recommend that you read this essay on "The Decline and Fall of American Conservatism," which just about says it all:

http://www.theobjectivestandard.com/issues/2006-fall/decline-fall-american-conservatism.asp

Sir Charles, I said profits AND admin costs. Take them all away, by how much do you think it reduces the total health care expenditures? Does it slow down the double digit annual inflation?

And do you really think accounting and actuarial are "almost completely unproductive"? You don't think a government run plan needs accountants or actuaries? Why are there actuaries working on Medicare then?

Tell me how your plan slows down health cost inflation, how it balances limited health care resources with continually increasing demand, and maintains the same level of care that the majority of Americans are receiving now and are happy with. If you are not addressing those issues you've done nothing to solve the problem.

AB,

I assume this thread is dead, but what I was trying to say re: actuarial, accounting and legal services is not that they are not valuable and necessary in the current environment -- but that the need for all of this work for individual health plans is by its nature grossly inefficient. Of course a single payer paln would need actuarial services, but on a rather different scale.

As for cost contaiment measures, I've been through them all -- the rise fo the PPOs in the late 1980s, the advent of utilization review and managed care, the implementation of mandatory generic prescription durgs, three tiered co-pays for prescriptions, mandatory second opinions for surgeries (soon abandoned), higher co-pays and deductibles, benefit caps on certain items, etc. I believe that these approaches have been more or less exhausted -- and have the perverse effect of spending significant health care dollars on non-health care services.

I think the elimination of these adminsitrative costs would be rather signficant in terms of reducing overall health care costs. I also think they would stem to some degree the rate of medical inflation by removing the middlemen. The heft of a single payer system in terms of negotiating fees would also help dampen inflation. Finally, I think we need to look at end of life care in this country, which has reached a level of madness. This is a cutlural and political issue as much as it is a health care issue -- we are spending a ridiculous amount of money on care that does nothing to enhance the lives of patients, but seems to be administered almost reflexively. I know it's a touchy subject, but it's one that I think is crying out to be addressed.