August 30, 2007 10:00 AM

Denmark Can Do It, But Not California...Or Texas...Or New York...Or Colorado...Or Wisconsin?

Ezra Klein is out once again attacking progressives in state legislatures for pushing to expand health care. It's a pretty tired, typical Washington, D.C. argument that attempts to imply that those progressives pushing to expand health care at the state level supposedly oppose efforts to do the same at the federal level - a disgusting, dishonest and factually inaccurate assertion. But what's interesting about his American Prospect article in particular is how truly negligent his argument is.

The central point of his article is that bargaining power is key to health care. If you have bargaining power, you can drive down the cost of drugs and medical services. I agree with that wholeheartedly.

But here's where his argument against state efforts to expand health care falls apart. After a 10 second Google search, you find the websites of the U.S. Census Bureau and the CIA World Factbook - and on those websites, you find out that many states are as big or bigger than many of the European countries that he trumpets for using their size to bargain for lower drug and health care prices. As just a few examples, California, New York and Texas each have either the same or more population and economic size than all the countries in Scandinavia...combined.

Hell, look right here in Colorado - a state in the exact middle of the country in terms of population (number 24 to be exact), and a state considering plans to expand health care. Colorado has just a wee smaller population than Denmark, which has universal health care. Then there is Wisconsin, whose state senate just passed a universal health care bill. It is actually bigger population-wise than Denmark. The idea that small countries like Denmark have the size to negotiate lower health care prices, but American states that are roughly as big or bigger than those countries defies logic. It's just a silly, absurd argument.

Ezra asks, "Do we really want 50 different health care systems, each with their own requirements, regulations, structures, and failings?" Ideally, no - we want a universal national system, and his repeated attempts to imply that progressives are ramrodding the debate into an either/or between state or federal solutions is dishonest - because the only progressives arguing that it is either/or is him.

Why do no progressives other than Ezra make such an either/or argument? Because it is ridiculous and counter-productive. By his either/or logic, states should do nothing at all that the federal government could also do. I'd like, for instance, a federal program to better aid workers that are displaced by job outsourcing. But does that really mean states shouldn't move forward to do the same thing in lieu of action from Washington? I think not.

In lieu of a national health care program, progress at any level - state, municipal, local, etc. - is progress. If you are in Washington and don't have to worry about your own health care, it's easy to say states shouldn't try to expand health care and that states should just look at the health care crisis, sit on their hands and do absolutely nothing so that we can all just wait for the Wise Old Men of Washington to solve the problem. It's easy to tell state legislators to tell their constituents without health care, "Sorry, there's nothing I can do, because Washington pundits tell me we should just do nothing until the federal government comes along and save the day." It's easy to make such an argument when you are probably not the one 18,000 Americans who will die this year because they can't get access to health care.

Making a perfect-is-enemy-of-the-good argument against states expanding health care in the face of 18,000 Americans dying a year is, at the very best, out-of-touch and callous, and more honestly, utterly immoral. In the absence of federal leadership to date, states have an obligation to do whatever they can to address the health care crisis. Whether that offends Washington pundits or not is beside the point - placating pundits should come second to saving as many lives as possible.

P.S. I want to make very clear that I do not think Mitt Romney or any other conservatives are right to make this debate either/or, or to try to claim states are the only arena that we can make progress on health care. No progressives I know - except Ezra - are making an either/or argument. Additionally, just because a policy is done at the state level doesn't mean its a GOOD policy. There are, for instance, a ton of problems with the Massachusetts health care plan. But there can also be really great health care policies at the state level too, such as in Wisconsin.