The federal government seems to be an odd beast, since as Ezra, Mark and Maggie seem to argue, progressives can get it to enact a comprehensive health care plan far better than anything the states can do-- yet if states enact their own plans, we can't depend on the feds to help them out with funding.

Mark is most optimistic in arguing that with a "perfectly conceivable 56 seats in the Senate in 2009, it should not be impossible to bring four or more Republicans over on a bill" for universal health care, yet he seems to argue that it will be impossible to maintain just the 51 votes needed to prevent "changes or cuts in Medicaid, S-CHIP or other programs."

You can't have an image of a federal government poised to overcome filibusters to enact universal coverage AND one that can't even muster a majority vote to keep Medicaid funds flowing to the states.

In fact, it's far easier to keep federal funds flowing, since even Republican state governors are lobbyists for more state money. Which is why states continued to have the money necessary to expand their health care programs by 20 million participants since 1991, despite the GOP controlling the House between 1995 and 2007. So history shows that keeping money flowing is actually far easier than structural change at the federal government level.

As I've said in the past, a federal solution would be the best and we hopefully eventually get there. But while as Mark argues, on paper Obama's, Edwards' and Clinton's plans may look really attractive, they won't be enacted as written.

The Kids Are Alright: As for Albany-- yep, it's an autocratic place, except for the fact that the legislators are elected on a one-person, one-vote basis, which means that autocrats like Senate Leader Joe Bruno fear losing elections. Which is why that REPUBLICAN-run chamber agreed to pass a minimum wage increase two years ago, long before the federal government did. That same Albany also extended health care to cover children in families up to 400% of the poverty line this session.

I work with state legislators around the country and they are generally less polished, less professional than the DC class of politicians-- most of the state legislators have day jobs -- but state legislatures also aren't constipated by US Senate rules that make all social progress almost impossible.

The Need for Federal-State Collaboration: Yes, as Mark notes, some states have some fiscal restraints on taxes and spending, which is why I've repeatedly said that this is not a state versus federal conflict. Under federal rules, it is far eaiser for progressives to raise revenues due to the 1974 Budget Act, so raising the revenues needed for health care should be the priority of progressives fighting at the federal level, since that is possible without needing 60 votes in the Senate.

On the other hand, states do have more trouble raising revenue but can enact structural reforms, once they have federal funds in hand, far more easily than federal progressives can.

So why not take advantage of the relative institutional strength of progressives at state and federal levels of government and develop a strategy that coordinates between those levels of government?

Focus on Wisconsin: Right now, I really want people to focus on the Healthy Wisconsin plan that the Wisconsin State Senate. Yes, it assumes funding help from the federal government, but it was created based on collaboration between a range of progressive groups and delivers most of the benefits that single payer advocates have argued for. What frustrates me is that the progressive media is largely ignoring the first time in decades that ANY legislative chamber anywhere in the country has enacted such a universal health care plan.

Instead, folks are just saying such a state-based health care beast is impossible without a real discussion of its merits and how progressives at the federal level could help make it a reality-- and replicate it across the country. YES-- we need funding from the federal government to make it work in more states, but getting the 51 votes for more money is far easier than getting the 60 votes needed to enact the same plan at the federal level.

Pass the Wisconsin plan in a few states and we are far more likely to see multi-state businesses start lining up to support a national health care plan to create more consistency in rules as they operate across the country.

But the bottom line is that we are far closer to having the 51 votes neccessary in the Senate to help provide the funding to make passage of Wisconsin plans in states across the country possible than we are to the 60 votes necessary to enact it or a variation at the federal level.

So let's promote a strategy of collaboration between federal and state activists that recognize the institutional limits at each level of government-- and take advantage of the strengths at each level to promote universal health care for all Americans. I doubt it looks as pretty as we'd like from a public policy wonk perspective, but it actually looks doable from a political perspective if we harness our strength at both the federal and state levels.