Democrats have controlled the California Legislature for 54 of the past 60 years. Since 2011, that legislature has been paired with a Democratic Governor, solidifying one-party rule. One out of every five Democrats in Congress is from California. Both of the state’s Senators and all of its statewide officials are Democrats. Trump barely polled 30% there.
With that degree of Democratic dominance, consider this puzzle: Why doesn’t California have single-payer healthcare? Single-payer is, after all, the shining dream of American progressives.
Why aren’t blue states doing more on their own to promote the Democratic agenda? It’s a question we should all be asking ourselves, not because single payer or any other Democratic policy goal is such a nifty idea, but because the federal government is so deeply broken.
Trump’s win is a crippling blow to an already badly weakened federal power. Regardless of the fate of Trump’s policy agenda, his election promises a power shift away from Washington. Congress has been one of our most broadly loathed institutions for a decade. Thanks to Trump, the Presidency may never again carry the imprimatur of prestige it accumulated in the decades since Roosevelt. Left, right or center, everyone should be looking more closely at the states for policy direction.
States have done this sort of thing before. Obamacare got its start in Massachusetts. California and Vermont were both actively pursuing single payer reforms before the Affordable Care Act was implemented. Why doesn’t California already have single payer health care?
There are some factors that make it harder to create complex policy solutions at the state level. Particularly in health care, existing federal programs and regulations create a baffling thicket of limitations, bureaucratic choke-points, and outright prohibitions. When California began exploring single payer a decade ago these constraints shut down their efforts.
How would a state level single payer plan deal with Medicare and Medicaid? A state cannot merely universalize those existing programs, but rebuilding them from scratch would be daunting. Trying to work alongside those programs promises endless conflicts, along with duplication of work and, most importantly from a political perspective, duplication of taxation.
Risk tolerance is lower at the state level, thanks to limitations on borrowing power. California, like 48 other states, is barred from running budget deficits. Though states can still sell bonds to fund certain activities, their debt is not denominated in a currency they control. If the eggheads with calculators make a costly error in shaping their state’s single payer health care experiment, they could create severe fiscal pain. By contrast, federal authorities could easily borrow to cover a shortfall while they work out the glitches in a complicated program.
On the subject of those eggheads, the federal government also benefits from a deep talent pool and a long tradition of professionalism. With few exceptions (Minnesota and Massachusetts stand out), state bureaucracies have less independence from political influence and a much more limited well of talent. Scale plays a part in this deficit. A federal agency recruiting from a pool of 350 million people carries some natural advantages over a state-level agency. Beyond scale considerations, history plays a role as well. Many states simply never enacted the strict civil service reforms that have refined the federal bureaucracy for more than a century.
One could argue that these obstacles are all fed and maintained by a single factor. Democrats long ago embraced a governing philosophy that downplayed state power. Blue states almost universally look to the federal government for leadership on key issues. This was not always the case.
States enacted the first laws on child labor, workplace safety, and minimum wages. Entire realms of critical government activity rose in an era of weak federal government. In an era when southern plantation owners blocked the federal government from investing in public infrastructure, states financed the Erie Canal. States were responsible for almost all the infrastructure development that launched the industrial revolution in the US.
Public schools developed to their modern form before Washington took an interest in the subject. Teaching, medicine, law, and legal professions were all crafted into their modern forms at the state level. Before the second Roosevelt Administration, states were the leading source of smart legislation on almost all matters of major importance. Having pressed for generations to strengthen federal power, Democrats now find themselves pinned beneath that crippled leviathan.
Is it better for the federal government to take the lead on matters of major policy impact? In the abstract, perhaps the answer is yes. In practical terms the answer is irrelevant. Whatever the inherent limitations of state level policymaking, that is our only alternative for the foreseeable future.
Though the obstacles are easy to see, advantages that states enjoy in crafting complex legislation are subtle, but decisive. Most important is a state’s superior potential for achieving political consensus.
Basically, it is easier to sell a complex idea to a few people than to a lot of people. The smaller your electoral pool, the easier it is to pass legislation. State politics also benefits from a narrower issue template and greater public trust. That’s how Massachusetts and New Jersey ended up with Republican Governors. Voters are not evaluating those figures on the same, much larger template of issues that influences their votes for Senate or President. A leadership figure who will travel no farther than your state capital is assumed to be more accountable than someone voters will send to Washington. It is often possible to build cross-partisan consensus on state level issues that would be impossible in Washington.
When it comes to cost and scale, California enjoys a particular advantage. California is big and rich, with a deep well of highly-educated talent that would be the envy of many of the world’s largest countries.
Cost is not holding California back from adopting single payer, at least not exactly. California is the country’s wealthiest and most populous state. It has a GDP roughly on par with France and the UK. Single payer may be expensive, at least by some definitions, but the cost doesn’t get easier to bear by adding Alabama and West Virginia to the program.
What makes the cost difficult to manage is the need to integrate with existing federal infrastructure. More to the point, California is already coughing up an enormous chunk of its potential tax base to the federal government. A disproportionate share of that money gets siphoned away to poorer (mostly red) states. In a strange irony, blue states will benefit far more than their red peers from a massive upper class federal tax cut.
That forms an introduction to the strange and counter-intuitive silver lining for the left in the victory of Donald Trump. Republicans will now get their chance to devastate the federal government. They will slash taxes and reduce Washington’s influence in every aspect of American life outside of women’s health and sexuality, which they plan to regulate like a Soviet state-run industry.
Collapsing federal power presents states like California with an opportunity. California has not enacted single payer health care for one over-arching reason – their decision to cede leadership to the federal government. A collapse of federal power may reinvigorate state efforts to craft and refine smart public policy. In same way Massachusetts inspired the ACA, a new wave of state innovations may spawn an era of policy innovation that could break us out of decades of quagmire. In chaos, there is opportunity. If Democrats ever again want to lead in Washington, let them prove that they can lead in California.