This article on Schwarzenegger’s halting, halfhearted attempts to bring universal coverage to California neatly encapsulates the central hurdle facing Republican reformers: Taxes. You simply cannot cover a new segment of the population without the addition of some revenues. And since Schwarzenegger’s advisors are already ruling out funding streams as minors as cigarette taxes, you’ve got just about no place to turn.
The example of Massachusetts has, in some ways, been destructive here, as governors have looked to that state and then done some throat-clearing about replication. Problem is, Massachusetts was a rare case that didn’t need new revenues. As I explained in this article, a previous wave of progressive health reform had already created a massive fund to care for the uninsured in the Commonwealth — which meant the Roney plan only had to redirect revenues, not create new ones. Add in a huge hospital-industrial complex, a very low number of uninsured residents, the threat of an expansive, universal care ballot measure, and the government’s withholding of a $750 million health waiver, and you’ve got an easy path to change.
That said, there is something to the federalist strategy on universal health care, wherein various states give it their best shot and create models for the rest of the nation. Problem is, it’s hard for states fund such experiments. That’s why I’ve some affection for Russ Feingold’s (mp3), which would guarantee a handful of states tens of billions to institute such plans. I’d amp up both the money allocated and the number of states included, but it’s an interesting compromise proposal that could, in a Democratic Congress, make it through the legislative process with few enemies, and even attract a presidential signature.