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.

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Maggie below echoes Ezra Klein's worry that failures at the state level on health reform will undercut national reform, but I think its a larger worry that too large focus on federal changes-- that will almost certainly be filibustered -- will draw energy away from and undercut the more likely-to-succeed state efforts.  The flameout of the Clinton plan did suck the life out of many state efforts.  As I've said, I think short-term state reforms and long-term organizing at the national level can go hand-in-hand, but I think the danger of overhyping efforts that fail at the federal level is a far greater danger to state efforts than vise versa.

And Maggie touched on a favorite point of mine when she compared the fight for national health care to the civil rights effort, since passage of the national Civil Rights Laws were preceded by many states passing state civil rights laws.   Frustrated by the failure of the federal government to pass anti-lynching and other civil rights laws, the states began moving on civil rights laws.

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A bit of conventional wisdom among the DC-based left is that, while it's nice for state legislators to play with health care toys in their little sandboxes, as soon as a Democratic grownup wins the Presidency, the states should just get back in their high chairs and wait for the feds to bring them national health care.

Ezra Klein in this month's Washington Monthly summarizes this Inside-the-Beltway wisdom (endorsed by Kevin Drum), but he both fails to deal with why it's unlikely, even with a Dem President, that we will get a real national health care program, and underplays the real likelihood that it will be the states, not the Feds, that drive change in health care policy.

It's the Filibuster, Stupid: Let's start with why putting hopes in federal change is so misguided. Rightwing legislators killed FDR's plans for national health care in the 1930s, killed Truman's plans in 1949, limited health care reform in the 1960s and 70s, and killed Clinton's health care plan in 1994. So with that track record, why is anyone so deluded as to think the rightwing GOPers won't use the filibuster to kill health care reform again?

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