By Matthew Holt

I can’t say that I often agree with libertarian Tyler Cowen and I think it’s pretty appalling that the New York Times gives someone with such, as Republicans used to say, “out of the mainstream” views a regular place to air them. Like this column saying that our health care system is better than those of other nations because we’ve got more Nobel prizes for example.

But today in his column Cowen basically says the we should pay for the expansion to the uninsured through reallocating current government spending (mostly on Medicare).

I agree. There’s no reason with the health care system sucking up 17% of the economy already that we can’t distribute that money better by reducing unnecessary care a la Wennberg and using the savings to provide good insurance and primary care for everyone.

But we won’t. So we get into arguments about where the extra $100 billion a year will come from, and the AHA is now waking up to the fact that it may have to find ways to do without a chunk of the $30 billion a year that Obama wants to use by cutting Medicare and Medicaid—even though there should be more like $200 billion a year to be cut from those two programs if they were designed & managed correctly.

And if you really want to find great cognitive dissonance. Here’s the story of a cancer surviving school teacher from Utah who’s a) damn lucky that she could get a teaching job with insurance and b) can’t (of course) leave that job even though she wants to return to running a day care center. After being used as a poster child by Consumer Reports for health system reform she said this:

“I was probably the most conservative person there,” she continues. “The people putting this on are much more liberal than I am. I’m a Republican from Utah County who is quote-unquote for smaller government. But I don’t know, maybe it is time for the federal government to come in and make some regulations and say what the rules are going to be when it comes to health insurance. Something definitely has to be done.”

Diane says she isn’t in favor of socialized medicine in America, and she’s not sure if President Obama’s plan to allow government-backed insurance as an option for private citizens qualifies as socialized medicine.

“I’m going to have to think about that,” she says. What she is sure of is that current conditions restrict a person’s freedom to work where they want to — and that’s not right.

I don’t know how to begin enlisting people like her for grassroots support for health care reform when they still believe that “little government” is good when “little government” is directly responsible for her problems.