One of Trump’s midterm rallies. Photo: Mark Peterson/Redux
Divided We Stand The country is hopelessly split. So why not make it official and break up?
The year is 2019. California’s new governor, Gavin Newsom, recently elected on a platform that included support for the creation of a single-payer health-care system, now must figure out how to enact it. A prior nonpartisan analysis priced it at $400 billion per year — twice the state’s current budget. There appears to be no way to finance such a plan without staggering new taxes, making California a magnet for those with chronic illnesses just as its tax rates send younger, healthier Californians house-hunting in Nevada and big tech employers consider leaving the state.
But Newsom is not alone. Other governors have made similar promises, and Newsom calls together the executives of the most ideologically like-minded states — Oregon, Washington, New York, Massachusetts, Connecticut, Maryland. What if they banded to create a sole unified single-payer health-care system, spreading risk around a much larger pool of potential patients while creating uniformity across some of the country’s wealthiest states?
Fifteen end up forming an interstate compact, a well-established mechanism for working together, explicitly introduced in the Constitution. They sketch out the contours of a common health-care market: a unified single-payer regime with start-up costs funded in part by the largest issue ever to hit the municipal-bond market. The governors agree, as well, on a uniform payroll tax and a new tax on millionaires and corporations set to the same rate with revenues earmarked for health-care costs. The Trump administration has already proved willing to grant waivers to states looking to experiment beyond the Affordable Care Act’s standards — primarily for the benefit of those seeking to offer plans on their exchanges with skimpier coverage. But the states can’t act unilaterally: The Supreme Court has ruled that Congress must approve establishment of any compact claiming authority that previously resided with the federal government.