Retirees Barbara and Joe Napier participate in a tea party rally, in Nashville in Dec., opposing the creation of a state-run insurance exchange under the federal health-care law. (Associated Press)

Conservatism isn’t cutting it for conservatives anymore, writes E.J. Dionne Jr. in a column today. What used to be conservative solutions to big problems are now so unacceptable to conservatives that their only recourse is to protest and obstruct the implementation of such laws, Dionne argues. Refusal to accept measures designed to entice conservatives into supporting Obamacare — Dionne’s examples are leaving some things up to the states, and implementing cost cutting — means a more nationalized and less efficient system, precisely the things conservative lawmakers would want to avoid.

Commenters, however, focused on reasons why those two conservative goals (small government, fiscal efficiency) themselves might be at odds. In most of the examples they came up with, bigger health-care systems are more efficient.   

jimb argues that American health care’s problems are system-wide, meaning the solutions probably would be too:  

— A recent Institute of Medicine (IOM) report identified one-third of U.S. health care dollars as going for waste and inefficiencies. Who can be for waste and inefficiencies? Only those who financially benefit from them, and their self-interest is without merit. So, what is the administration and the Congress doing to help health care eliminate waste and inefficiencies?  
— Governor Romney, when visiting Israel, remarked on the cost of its health care: 8% of GNP, less than half the cost of U.S. health care, quality care vs. uneven quality in the U.S., and health care for all Israelis, while the U.S. has tens of millions without insurance or with meager insurance. Moreover, Israel’s health care cost has been stable for several decades while the U.S.’s health care costs continually increases. Perhaps the administration and the Congress could enlist Governor Romney to lead a team to examine Israel’s health care system to determine the key aspects and then develop a plan to implement those key aspects here?  

1toughlady agrees. Jimb’s example of a system that works better than ours for less money is imposed by a national government:

The Israelis do the very thing the GOP rails against here: They determine the best treatment course for an illness and pay for that treatment, and bargain for their medicines. That is precisely what they want to block here, because they are bought and paid for by the health care lobby.

mongoose1, however, sees other quasi-nationalized American industries and isn’t impressed:

Some examples of “single-payer” like systems run by government: the U.S. Post office, AMTRAK, Social Security. All are broke and either cost more or deliver less than their free-market competitors, or both. 
Examples of medical procedures not subsidized by the government that have gotten significantly better and cheaper over the last 15 years: Lasik eye surgery and breast implants.  
Economic lessons learned: free-markets work, government price fixing does not. See Milton Friedman for more.  

PostScript feels compelled (by herself) to point out that single-payer DOES work in many countries, and high regulation of the health-care industry does as well.  Lasik and breast implants are both voluntary, non-medically-necessary procedures the patient is at leisure to get whenever he or she wants. PostScript has no desire to wake up after a car accident in an emergency room that wants to make a profit off her. Or to wake up in the parking lot of the ER because they have every right not to admit her.      

jameschirico is thinking about the next set of regulations the health industry will need, which is a great reminder that time is passing and we have other things to talk about than rhetorical objections to real-world solutions that we’ve been getting nowhere on for two years:

Insurers had their profit/admin. costs capped; providers, pharma, equipment makers did not. Although the emergency rooms loss by hospitals will become nominal, nothing in Obamacare says they must pass those savings to the consumer. A cap would accomplish it. 
There is a profit motive that has 20% of tests done without medical need. To cull this practice providers should be paid on a patient number in medicare instead of procedure number. Tests done outside of 80% of treatments get a 30% copay half from patient, half from doctor. Tort reform would also help (although it did not lower tests in TX).

4peas offers a possible rhetorical solution that would allow Republicans to support some of their own ideas again. Republicans don’t have to think government can be efficient in order for government to regulate efficiency: 

Republicans do not believe in an “efficient” government, however, government can make our economic system and our health care system much more efficient by enacting responsible legislation.

Responsible legislation! Something several prominent Republicans are currently in a position to work on! Or will be whenever they get back to work next week. At this point PostScript is not inclined to listen to them on the subject of efficiency.