Unhealthy obsession.

• Author: Thompson, Adam
• Position: LETTERS - Letter to the editor

Ezra Klein says that the states are "structurally incapable" of sustaining health care programs because of their vulnerability to recessions and inability to run deficits ("Over Stated," July/ August). Yes, some state programs have failed for fiscal reasons, but most were based on the unstable ground of insurance providers. So did the programs collapse, or the foundation under them? Klein also fails to address the case of European countries that have maintained successful programs.

In fact, states are better suited to do the heavy political lifting needed for universal coverage to succeed. Unlike Congress, states don't need to contend with filibusters. Additionally, state legislators are less insulated from their constituents than congressional lawmakers are. It seems a bit ironic for Klein to look to Congress to solve the problem. After all, every federal attempt at universal coverage over the past eighty years has failed spectacularly.

In addition to ignoring this federal failure, Klein also manages to ignore the states' successes. In just the last fifteen years, state-run programs have added at least 20 million people who were previously without coverage. Combined, state programs cover more Americans than Medicare.

The states are also learning from each other's struggles. In New York, children's coverage was expanded to 400 percent of the poverty level using the joint state-federal SCHIP (State Children's Health Insurance Program), providing all but universal children's care. Countless other states are raising their SCHIP coverage levels as well.

The boldest plan yet comes from Wisconsin, which circumvents the flawed insurance premium system altogether by instituting payroll-based funding. The plan would cover all residents not already covered by public programs, and would provide comprehensive...