Let the states decide?

As the Constitution says, those powers not expressly written as the responsibility of Washington are, by default, differed to the states. Could this also work with health care?

States on their own wouldn't be able to stem the rising tide of premiums and costs; Massachusetts' "RomneyCare" hasn't pushed the nation's private insurers to work more efficiently. An idea that has been floated recently, and received a certain amount of bipartisan support (which is a huge deal in this polarized debate) is to set up a government public option but let state legislatures decide whether or not to offer the program in their state. This, to me, seems like a perfect solution. States like California with a healthy Democratic majority (though with such a deeply polarized Assembly, there would be little to no crossover) would be able to pass it, while those states that felt like opting out would be able to.

The key to this, of course, would be to keep the opting in and out fluid. States should be able to drop the plan if it is excessively hurting their insurance companies, and if a state feels like its neighbors are benefiting it should be able to join in the fun.

Unfortunately, this wouldn't leave it up to the voters. I haven't seen anything about running a referendum to decide such matters, and I think that would be most productive (since public support far outstrips congressional support for a government plan) It'd be delightful if there wasn't such a disconnect between Congressmen and their constituents, but given the outspokenness of the opposition, it's pretty understandable. Besides, state legislators are ultimately beholden to those constituents, and they would do their best to read their district before making an impulsive decision on the matter.

The last little caveat is that some of the states most likely to forgo the public option need it most; some states in the South are only served by one or two insurance companies, and breaking those monopolies would make a huge impact on coverage and pricing.

Having an initial run of the public option, though, could finally bring a spirit of pragmatism to the debate. If people in the more conservative states can talk to family and friends in other areas of the country and hear real-life experiences, we can, as a nation, decide if this is the way forward.