Wednesday, November 26, 2014

Single payer

One place where conservatives have failed in the Obamacare debate is that we have failed to articulate why we are fearful of single payer, one of the potential evolutionary endpoints of this legislation (or what may replace it.)

This story out of Pakistan is from NPR, an organization that is rarely considered a bastion of conservative principles.

Over the years, government teaching jobs in Pakistan have routinely been handed out as political favors. Thousands of so-called "teachers" pocket wages but do not go to work.
...estimates four out of 10 teachers in the province never set foot in a school: "Some of them run shops, some work in the media, some for feudal landlords."
...nearly half of Pakistan's 58 million kids of school age are not in school.

Single payer prevents patients from voting with their feet.  Management becomes a bureaucracy.  It is invariably easier to manipulate metrics than to change policies, procedures, personnel and infrastructure. The goals of every five year plan will be exceeded by a safely defensible margin regardless of actual performance.  Nobody looks too hard because no link in the chain can withstand scrutiny.

It is a very short step from cooking numbers to a spoils system where "reliable" people are placed in the most critical positions.

Just like the "teachers" in Pakistan.

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