Obamacare Proves the Virtues of Federalism

As a federal program, Obamacare could never accommodate the many Americans who want a different approach.

No issue in recent years has polarized Americans as much as Obamacare. It produced a party-line vote in Congress, a near-fatal court battle, a revolt by states that refused to run exchanges or expand Medicaid, dozens of House votes to repeal it and, now, a bungled launch that could be its undoing. It's a barroom brawl that never ends.

Barack Obama's health care plan hit nerves that are still radiating pain among many people. But being a federal program, it couldn't accommodate the many Americans who want a different approach. It's a zero-sum game. One side has to win, and the other has to lose.

It didn't have to be that way. Why is same-sex marriage, which was once politically preposterous, faring so much better than health care reform? Why has liberalization of marijuana laws happened without provoking threats of secession? One simple reason: Those changes have taken place at the state level -- and only in states that chose them.

They're the product of an ingenious but often unappreciated ingredient of our system of government: federalism. In a nation with 317 million people spanning a continent, there are great differences in culture, politics, religion and barbecue. What allows us to be united states rather than warring ones is that on many things, we can agree to disagree.

Just because Vermont and New Hampshire are the Mary-Kate and Ashley of states doesn't mean they want the same things. One has a state income tax, and one never will. The people of Maryland wouldn't want to live under the laws that suit Mississippians, and vice versa. Decentralization allows peaceful coexistence.

State prerogatives have long been a cause of conservatives, but some liberals have come to prize them as well. Oregon successfully fought off a federal court challenge to its law allowing doctors to prescribe medicines for patients who want to end their lives. If legalization of marijuana had to win the approval of Congress, Coloradans would still be waiting for it.

Federalism is equally suited to the right and the left. Gun-rights advocates can have their way in Texas, while gun-control supporters can prevail in California. Laws allowing the carrying of concealed handguns gained attention when Florida passed one in 1987, which soon spread. But some states, like New York, exercise considerable discretion over who gets a permit.

Supporters of gun control often complain that permissive policies in some states undermine tough ones elsewhere. But the Law Center to Prevent Gun Violence contends that “states need to adopt strong gun laws because gun laws really do matter. Many of the states with the strongest gun laws also have the lowest gun death rates nationwide.”

Most of the effects of a state's laws are felt by its residents. If they don't like those consequences, they have the power to bring about a change in the law. And if they can't get it changed, they have the option of moving to a state whose laws they like better.

On policies made in Washington, those same people have far less say -- and they can't escape. The combination can breed intense resentment. One reason abortion has been a live wire for so long is that the 1973 Supreme Court ruling in Roe v. Wade imposed the same basic rules on every state. More latitude would have defused much of the emotion.

Even in immigration policy, where the feds necessarily take the lead role, there is room for diversity. Some states grant in-state tuition at public universities to young people brought here illegally by their parents, and some states deny it. Some give driver's licenses to undocumented foreigners, and some don't. Those here illegally can make their choices accordingly.

Health insurance reform might have taken a similar route. Massachusetts, in fact, enacted a plan on which Obamacare was modeled. The fact that no other state adopted it should have been a clue it wasn't ready for Broadway.

Had several other states successfully implemented similar plans, they would have dispelled doubts and provided useful real-world data on how to make this option work. At some point, its performance might have overcome enough doubts to evoke broad bipartisan support for a national version.

The federalism model doesn't satisfy ambitious reformers who are certain there is only one good way to address an injustice. But that's not a bug. That's a feature.

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  • Caleb Turberville||

    When's Suderman gonna fill us in on the recent proposal to extend cancelled insurance plans until after the midterm elections?

  • Anonymous Coward||

    If you like your plan, you can keep your plan. Period. Or until TEAM Blue gets safely past the next general election.

  • Brett L||

    These plans are sub-standard, but we can't have the Republicans winning the Senate.

  • reardensteel||

    What I can't believe is how surprised some people are. It's not like it was hard to see this coming:
    http://finditstrange.blogspot......obama.html

    That post is from 2009.

  • Sevo||

    "Health insurance reform might have taken a similar route. Massachusetts, in fact, enacted a plan on which Obamacare was modeled. The fact that no other state adopted it should have been a clue it wasn't ready for Broadway."

    Instead, it was seen as something a supposed R could push through, therefore a D had to match it or come in second in the 'free shit' contest.

  • UnCivilServant||

    But some states, like New York, exercise considerable discretion over who gets a permit.

    Yes, you must be party elite, connected to party elite or rich and famous enough to garner bad press to get a permit. Exceptions made for enforcers of party will.

  • Richard||

    Yesterday I created an account on Vermont's state-run Obamacare system and applied for coverage. As I expected my pitiful income qualifies me for Medicaid under the new rules. I did have an option to buy a bronze/silver/gold plan but the calculated subsidy value was $0. Why, I don't know, and neither did the Navigator I asked.

    The system had Oracle logos all over it, lots of security theater, and made me type in my address three times. The impression I got was that, in the end, all it did was send my name and address to the Vermont Medicare department. I wouldn't be surprised if I got a paper application in the mail shortly.

  • Brett L||

    You get no subsidy because you are eligible for Medicaid. Subsidies are for those who are not eligible for Medicaid but less than 400% of the poverty line. So that part is actually working correctly. Although how anyone who qualifies for Medicaid could afford an unsubsidized insurance plan...

  • UnCivilServant||

    Well, duh, if their declared income is too low, they must have it hidden from the IRS and are thus guilty of tax fraud too. They can afford it as easily as the rich can take all the new taxes they keep begging to pay.

  • R C Dean||

    Why, I don't know, and neither did the Navigator I asked.

    Christ on a cracker, that's OCare 101: No subsidies for the Medicaid-eligible.

    This has to be a very common question, and the Navigator didn't know?

  • Richard||

    The best part is that I overestimated my 2014 income. If I had overestimated it more, enough not to qualify for Medicaid, but enough to get a whopper subsidy, would I be persecuted when my income was insufficient?

  • DarrenM||

    Broken compass.

  • Hillary's Clitdong||

    My Boy friend makes $75/hour on the internet. She has been without a job

    LOLWUT

  • R C Dean||

    She's doing her webcam ass-to-mouth as an indepedent contactor, is my guess.

  • Juice||

    Even in immigration policy, where the feds necessarily take the lead role,

    How is this necessary? Also, the constitution grants the federal government with the power to regulation naturalization. It gives no power to regulate immigration.

  • bassjoe||

    "One reason abortion has been a live wire for so long is that the 1973 Supreme Court ruling in Roe v. Wade imposed the same basic rules on every state. More latitude would have defused much of the emotion."
    -------
    If Roe v. Wade did simply uphold a US Constitutional right, then why exactly should the states be given "latitude"? Isn't it like saying states should be given "latitude" in outlawing slavery?

  • AlmightyJB||

    But communism only works if everyone does it.

  • Butler||

    ^this. This is the fact that progs won't admit, but is critical to any prog agenda.

  • DarrenM||

    But if everyone can successfully be forced to obey, it's a win-win. Our fearless leaders win by showing how wonderfully brilliant they are. The people win by being forced into behaviour that is really for their own good anyway.

  • uhclem||

    There are no virtues to federalism.
    http://tinyurl.com/lz7f2ra

  • bmelton||

    Gun-rights advocates can have their way in Texas, while gun-control supporters can prevail in California.

    This is probably not true, but of course depends upon how you interpret the Constitution. States' rights may reign supreme *so long as the states do not infringe on the rights of its citizenry*. What has seemingly been long forgotten in this country is that the reason d'etre of the federal government is not to bribe the electorate with prizes, but to uphold the individual liberties of the citizenry against the state.

    In an ideal nation that strictly adheres to the Constitution, states would be free to enact whatever laws they choose, except for any laws that would infringe the rights of individuals, and the purpose of the federal government would be to ensure that those individual liberties were held sacred, and free from overreach by the state.

    Regrettably, the system we currently have involves both state and federal overreach, and a judiciary that seems to start with the assumption that the government is right.

  • Russ Davis||

    Having been civilized and educated, The Founders, unlike Steve, understood that "same sex marriage" was a meaningless term only even proposed, much less promoted, by the mentally incompetent belonging in insane asylums in constant delirium. Giving words their rational meaning those pretending to have a "same sex marriage" (as delusional an oxymoronic notion as a four-sided triangle) can't, coherently and rightly understood, "have sex" since such requires two sexes in order for it to be, and even "homosex-" itself is a "gay invention" the rational have always known it to be. Read "The gay invention" at www.touchstonemag.com. Also see www.DrJuithReisman.org for how that the Kinsey nazi childmolesting monster's delusion has almost singlehandedly resulted in the overthrowing of our morals jurisprudence.

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