Universal Health Care...

...is failing to deliver when tried on a state basis. And for most of the obvious reasons. Ezra Klein takes a look:

Why the "laboratories of democracy" can't achieve universal health care

Washington State, for instance, opted for a Clintonian-style program. In 1993, it passed the Washington Health Services Act, which sought to tame the excesses of health markets and use the state’s regulatory powers to mandate universal coverage, force insurers to offer comprehensive benefit packages at affordable prices, and pool purchasing power so all residents could buy in. Because the insurers would rebel against this scheme to rip apart their business model and end their ability to price out the sick while attracting the well, the state demanded that all insurers who wanted access to Oregon’s market become certified through the state—that way, they couldn’t undercut the program. But the insurers took a harder line than expected and instantly rebelled against the arrangement; many went so far as to cease doing business in the state. Others instantly jacked up premiums, creating total chaos. The next year, the Republican revolution washed over the statehouse, and by 1995 the new GOP majority had repealed most of the plan’s elements, including the parts forcing insurers to participate. By 2000, not a single insurer remained in the now-voluntary system. Today, 13 percent of Washington’s population is uninsured, compared with just over 10 percent in 1992. The state spends 12 percent of its gross state product on health care, just 1 percent less than the national average.

Other states have had similar experiences, even when there was no Republican-led backlash.

Like Hawaii’s experiment, TennCare seemed to work, at first. A few years after its inception, it covered a quarter of Tennessee’s population. But it ultimately met with exactly the same fate as Hawaii’s program. A fiscal downturn created greater need and insufficient tax revenues. Costs increased. When voters rejected a tax hike, the state began cutting benefits. By 2005, Democratic Governor Phil Bredesen had dissolved much of the program, leaving more than 300,000 Tennesseans without coverage. “I say to you with a clear heart,” said Bredesen, “that I’ve tried everything. There is no big lump of federal money that will make the problem go away.”