We've talked a fair amount about universal health reform going through the states. Massachusetts is currently implementing a plan, California is floating one, and a variety of others, from Pennsylvania to Illinois to Connecticut, are hinting that they'll follow suit. Politically, I'm all for these initiatives. As a policy matter, however, they're doomed, for reasons I explain in the latest Washington Monthly. The trick is going to be converting the energy of the states into momentum for a national solution. Hand it over to the laboratories of democracy, however, and their solutions will collapse, and the push for reform will, I fear, be set back.
The idea of giving universal health care a little more time in the laboratories of democracy may sound tempting to certain cautious, bipartisanship-loving Beltway observers. But letting states continue to take the lead would be disastrous, for one very simple reason: providing health care for all citizens is one of those tasks, like national defense, that the states are simply unequipped to manage on their own. The history of state health reform initiatives (and there's quite a history) is a tale of false hopes and great disappointments. The deck is stacked from the start, and the house—in this case the insurers, the providers, and other agents of the status quo—always wins. The new raft of reforms may prove different, but they probably won't. Universal care advocates must be realistic about that, and think hard about how to convert the energy in the states into a national solution before the current crop of novel experiments fail—because fail they almost certainly will.
The current appetite for universal health care in state capitals may seem thrilling and unprecedented to some, but to those who follow the issue it carries an unsettling charge of déjà vu. Over the years, states have tried programs of many different ideological and economic persuasions. All of them failed, and not because the programs were insufficiently inventive, but because states are structurally incapable of sustaining them.
