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As States Lead On Health Care, D.C. Elites Say Only D.C. Elites Can Save America

07/12/2007 01:38 pm 13:38:13 | Updated May 25, 2011

Only in Washington, D.C. can people look at data, success and advances in America's states, and still insist that only the Beltway's Wise Old Men, Serious Policy Experts, Self-Described Political Gurus and Universe-Rescuing Pundit Superheroes can solve our country's problems. Yes, only inside I-495 where theses Gods of Mt. Olympus frolick, can some so-called "progressives" not only downplay - but aggressively attack - courageous state legislators that are moving forward with progressive solutions to the most challenging moral crises.

Case in point is Ezra Klein, who penned a sad article in the Washington Monthly about health care that is now being circulated in political circles. As if blaring a homeland security alarm from the gilded rooftops of D.C.'s office buildings, Klein lectures progressive state legislators to stop wasting their time working to move their states toward universal health care. Why? Because, he says, the only solution can come from Unbelievably Smart and Important Washington People. Yes, that's right, he says "states are no good at delivering universal health care" - the implication being, of course, that Wise Men in Washington have been just incredibly successful at the endeavor.

I'll let Nathan Newman at the Progressive States Network (on whose board I serve) do the talking here. In his new article that exposes Klein's article as typical self-congratulatory D.C. propaganda, he shows that the facts are, in fact, exactly the opposite - states are far, far better and more experienced at delivering health care than The Glorious Leaders of Washington. Though many Washington-based and Washington-focused progressives likely haven't bothered to take a look, the data shows that the states have quietly taken the lead in providing more and more health care to more and more Americans. While no one argues that the federal government has played a role in these successes, that role has been primarily financial - not administrative. That is, the feds have cut some checks, but the hard work of actually setting up and running the systems has been done not by the Serious Thinkers or the Deities of Pennsylvania Avenue, but by the states.

Newman proceeds to discuss both the political and public policy advantages of targeting universal health care campaigns at state legislatures. One thing he doesn't mention (but I will) is the historical idiocy of claiming that states - many bigger than European countries that provide national health care - cannot provide universal health care. Spend 5 minutes on Wikipedia, and you'll learn that Canada's much-vaunted universal health care system began as a provincial initiative. The provinces provided both the better political opportunities, and ultimately the better initial implementation platform that ended up launching the federal program.

None of this is to say that the efforts to pass a universal health care system at the federal level are a waste - they aren't, they are absolutely critical, but it's not either/or.

Lot's of folks in national progressive circles - donors, organizational leaders, activists - talk a terrific game about truly respecting states, and wanting to devote real resources to fighting battles in the states, as the conservative movement has done so successfully. At some level, they seem to vaguely sense that there are very important reasons why the conservative movement is not as DC-focused as the progressive movement, and why it has spent such huge resources aimed at dominating state policy - especially health care.

Yet, when it comes time to devoting real resources to the states, many (but certainly not all) of these same folks slink away or, like Klein's article, unleash half-baked attacks on the successes that are being forged in the states. These folks are either too obsessed with the the pseudo-celebrity fanfare of being able to meet a U.S. Senator (wow what a thrill!) or believe that by actually focusing on the states they supposedly acknowledge that their work in Washington is less relevant.

But it's not - it's not an either/or. Federal AND state campaigns are critical if we are to enact public policy reforms that help the middle-class and if we are to build a movement that truly is national.

P.S. I know D.C. isn't a state, but Ezra, I'm betting right now you wouldn't be all that bummed if D.C. had its own universal health care plan. We'll wait until after you recover from your $2,000 root canal to hear the answer...

P.P.S. I dialed this post back from its initial, well, heat. After spending the last few years working to build up state capacity on issues like health care, I was more than a little ticked off that someone on the progressive side would use their platform to try to damage burgeoning state efforts, when many of them are showing real success. I do like Ezra, and have trumpeted his work in the past, so I apologize if my first crack at this post had a little too much tone - it was the frustration and fatigue of endless travel and meetings and organizing for state infrastructure that was talking.

UPDATE: From the Department of Circular Logic, we get Ezra's response claiming that because states have yet to pass a great universal health care program, states cannot ever have a great universal health care system. But then, Ezra - the federal government has yet to pass a great universal health care program, too - so does that mean it cannot do it? I think not. That's circular logic. Just because something hasn't happened in the past, doesn't mean it cannot happen in the future. Now ain't that a truism...