If I can intrude on Jon's turf for a second, I wanted to add a few thoughts about Phil Bredesen, the supposedly one-time frontrunner for HHS secretary. His non-nomination nomination is old news, but the intense flak he caught seems to have made the Tennessee governor a minor saint for the right; as the Wall Street Journal editorial page writes today,
For MoveOn and the single-payer lobby, Mr. Bredesen's approach is unacceptable because government doesn't run everything. In a petition it has been circulating, MoveOn says that Mr. Bredesen would be a "bad choice" to run HHS because he "gutted" TennCare [the state's Medicare supplement] and made a "fortune acquiring and running HMOs." Never mind that TennCare was breaking the state before Mr. Bredesen arrived.
A big part of the Bredesen defense is that patient advocates in Tennessee refused to compromise with him, forcing him to make drastic cuts. But the real problem in Tennessee wasn't the left but the right; as I've noted before, Tennessee draws almost all its revenue from sales taxes because a virulent, and very popular, anti-tax lobby draws blood any time the possibility of an income tax is raised. They sank Bredesen's predecessor, Republican Don Sundquist, for having the temerity even to explore alternative state revenue options. Believing that only an income tax could save TennCare but knowing it was a non-starter, Bredesen went in for drastic cuts.
I am not here to praise or apologize for Bredesen's choices. But focusing on Bredesen solely as a slash-and-burn free-marketeer misses the real nature of Tennessee politics and, I think, a strong argument for a national health care system. Tennessee had a great, if bloated, system in need of reform, not gutting. But the sharp rightward turn in state political sentiment in the 1990s--a turn that, amazingly, continues to gain speed today--means that any effort to raise revenue is a non-starter, and that the only acceptable reform is to eviscerate the system. It's a case in point for the downside to state-level experimentation, and evidence that, at least in conservative states, voters are willing to move backwards, not forwards. That's no way to build a better health-care system.