supreme court justice brandeis referred to states as *laboratories of democracy*, idea that states can/should engage in different policy experiments without interference from federal government, assumption is that successful experiments can be replicated by other states or by national gov't...
current era of *devolution* has ostensibly restored states' autonomy to act innovatively following several decades of nation-centered federalism arising from 1930s new deal...
while there is fair amount of evidence indicating hypocrisy of conservative/ republican - and some neo-liberal democratic - motivation for renewed state-centered federalism (proponents are not interested in returning power to the states, they want to completely eliminate certain government programs/policies associated with new deal/fair deal/great society), present situation conceivably offers progressives (whomever *they* are) opportunity to test brandeis' notion...
unfortunately, since scarce resources are fact of life, choices have to be made re. how to allocate what's available, differences among states with respect to economic wealth, political system characteristics, interest group strength, issues that folks organize around are pretty large, one consequence is increased difficulrt of building broader social movements...
number of congressional health care proposals have been floating around for years: *from* limited changes such as expanding existing medicaid program to cover some of the currently ineligible uninsured *to* requiring that employers provide some minimum level of health insurance for employees while providing federal subsidies or creating purchasing coops for small businesses *to* assigning states primary responsibility for establishing health care alliances that would negotiate with private-sector for coverage/ services *to* authorizing state to/requiring that states create newtorks of affiliated providers, enroll participants, collect premiums, pay providers (in sum, a form of single-payer)...
certainly no indication that congress is going to act on any of above any time soon, in meantime, states have adopted variety of policies (i posted a bit of info some time ago on so-called "pay or play" plans in massacusetts and minnesota, but i know little about either and would be interested in hearing from anyone who has experienced them)...
i also posted some info about hawaii's 30 yr old health insurance system requiring employers to cover their employees, those not covered - including unemployed, self-employed, part-time workers - receive care through state-funded managed-care program...
most physicians providing medical treatment in hawaii are part of state medical services association, smaller number have practices affiiated with kaiser hmo...
primary care, prevention, outpatient care is emphasized, direct government role is limited, state sets and governs cost control measures, there exists - for all practical purposes - universal health insurance, spending is about 9% of gross state product, compared to national average of about 15%...
were states *laboratories of democracy* in sense that brandeis suggested, hawaii wopuld offer policymakers a sense of how one type of comprehensive change can work, ain't no one moving in that direction, piven and cloward may well be correct in asserting that repeated use of direct action tactics produces policy benefits for working class and low income folks even if specific protest action does not lead to specific policy change... mh