The PostgreSQL ON CONFLICT clause in INSERT statements provides "upsert" functionality (i.e. update an existing record, or insert a new one if no such record exists).  This functionality is supported in SQLAlchemy via the on_conflict_do_nothing and on_conflict_do_update methods on the PostgreSQL dialect's Insert object (as described here):
from sqlalchemy.dialects.postgresql import insert
insert_stmt = insert(my_table).values(
    id='some_existing_id',
    data='inserted value'
)
do_nothing_stmt = insert_stmt.on_conflict_do_nothing(
    index_elements=['id']
)
conn.execute(do_nothing_stmt)
do_update_stmt = insert_stmt.on_conflict_do_update(
    constraint='pk_my_table',
    set_=dict(data='updated value')
)
conn.execute(do_update_stmt)
I am using flask_sqlalchemy, which manages SQLAlchemy's engine, session, and connections for you.  To add an element to the database, I create an instance of my model, add it to the database session, and then call commit, something like this:
from flask import Flask
from flask_sqlalchemy import SQLAlchemy
app = Flask(__name__)
db = SQLAlchemy(app)
class MyTable(db.Model):
    id = db.Column(UUID, primary_key=True)
    data = db.Column(db.String)
relation = MyTable(id=1, data='foo')
db.session.add(relation)
db.session.commit()
So the Insert object is completely wrapped and obscured by flask_sqlalchemy.
How can I access the PostgreSQL-specific dialect methods to perform an upsert?  Do I need to bypass flask_sqlalchemy and create my own session?  If I do this, how can I ensure no conflicts?
You must have INSERT privilege on a table in order to insert into it. If ON CONFLICT DO UPDATE is present, UPDATE privilege on the table is also required. If a column list is specified, you only need INSERT privilege on the listed columns.
Introduction. PostgreSQL lets you either add or modify a record within a table depending on whether the record already exists. This is commonly known as an "upsert" operation (a portmanteau of "insert" and "update").
The UPSERT statement is a DBMS feature that allows a DML statement's author to either insert a row or if the row already exists, UPDATE that existing row instead. That is why the action is known as UPSERT (simply a mix of Update and Insert).
It turns out you can execute a lower-level statement on the db.session.  So a solution looks something like this:
from flask import Flask
from flask_sqlalchemy import SQLAlchemy
from sqlalchemy.dialects.postgresql import insert as pg_insert
app = Flask(__name__)
db = SQLAlchemy(app)
class MyTable(db.Model):
    id = db.Column(UUID, primary_key=True)
    data = db.Column(db.String)
    def __init__(self, _id, *args, **kwargs):
        self.id = _id
        self.data = kwargs['data']
    def as_dict(self):
        return {'id': self.id, 'data': self.data}
    def props_dict(self):
        d = self.as_dict()
        d.pop('id')
        return d
relation = MyTable(id=1, data='foo')
statement = pg_insert(MyTable)\.
    values(**relation.as_dict()).\
    on_conflict_do_update(constraint='id',
                          set_=relation.props_dict())
db.session.execute(statement)
db.session.commit()
The as_dict() and props_dict() methods in my model class allow me to use the constructor to filter out unwanted properties from the incoming HTTP request.  
An alternative approach using compilation extension (https://docs.sqlalchemy.org/en/13/core/compiler.html):
from sqlalchemy.ext.compiler import compiles
from sqlalchemy.sql.expression import Insert
@compiles(Insert)
def compile_upsert(insert_stmt, compiler, **kwargs):
    """
    converts every SQL insert to an upsert  i.e;
    INSERT INTO test (foo, bar) VALUES (1, 'a')
    becomes:
    INSERT INTO test (foo, bar) VALUES (1, 'a') ON CONFLICT(foo) DO UPDATE SET (bar = EXCLUDED.bar)
    (assuming foo is a primary key)
    :param insert_stmt: Original insert statement
    :param compiler: SQL Compiler
    :param kwargs: optional arguments
    :return: upsert statement
    """
    pk = insert_stmt.table.primary_key
    insert = compiler.visit_insert(insert_stmt, **kwargs)
    ondup = f'ON CONFLICT ({",".join(c.name for c in pk)}) DO UPDATE SET'
    updates = ', '.join(f"{c.name}=EXCLUDED.{c.name}" for c in insert_stmt.table.columns)
    upsert = ' '.join((insert, ondup, updates))
    return upsert
This should ensure that all insert statements behave as upserts.
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