Blogger Ezra Klein has a new piece at Washington Monthly that expresses doubt that state-based health reform will be ultimately successful. It wasn’t convincing.
There are certainly arguments about why reform at the federal level is preferable, more sustainable, and even more straightforward policy-wise. He is right, for example, that the federal government is better able to keep programs going during economic downturns, since it has the ability to run deficits, which are more limited at the state level.
But there’s clearly opportunities at the state level, including California, so why wait? His examples of failed state efforts lacked the context of comparison with all the failed efforts at the national level, from Teddy Roosevelt to Harry Truman to Richard Nixon to Bill Clinton. The history of health reform has lots of failed attempts at the state *and* federal level, but that’s not a reason to stop trying at either level.
And California exceptionalism runs rampant: we think of ourselves as a nation-state anyway, and of DC as a far-away place that take a full day to get there, where people go home at our 2pm.
In bringing up California, he goes astray. (I think he’s also mistaken on the Illinois plan, which doesn’t have the individual mandate as he said.) His critique of the Schwarzenegger proposal is reliance on federal money, which he is concerned could be rejected or taken away at another time.
But what important to the Governor’s plan (and AB8) is that the federal money is simply *matching* money that California is entitled to. California spends the least amount of money per Medicaid patient as any state in the nation, but as a result, we don’t get our fair share of federal money. However, if California puts more money on the table, then we get our mandated match from the federal government. For both proposals, the vast majority of money does *not* require federal approval, since it simply is the match that every state is required to get, and is money that frankly California has been leaving on the table for years and years.
Could a future president mess with this? Possibly, but that Congressional fight would not just be with California, but with most states. Now that’s a fight that we can win.