There are clearly two Americas, and one is holding the other back. At least this is likely the view held today by many Progressives. To use the terminology of the famous nuclear war strategist Herman Kahn (though obviously in a different context) there is the A-country, and there is the B-country [*See Note Below*]. The A-country is making progress, where the government is involved in creating communities, taking care of the vulnerable, and creating equal opportunity for all. This is the Northeast, parts of the great lakes (primarily Illinois and Minnesota), and the entire west coast. These are places that routinely vote for Democrats and have reliably Progressive policy initiatives. It is also where the most interesting stuff is happening, and where we are most likely to find conditions conducive to a good life (for the Progressive at least).
Then there is what Progressives would likely think of as the B-country; this is all the rest. Libertarian and conservative politics prevail, the government does far less to provide equal opportunities to all citizens, and the people generally have somewhat “backward” or “traditional” values. Of course, from the perspective of libertarians and conservatives, much of B-country is preferable to A-country; they see the policies of A-country to be smothering initiative and violating individual rights. These different ways of life are supported by different sets of values.
One problem, you might think, with the standard progressive strategy of the past 30 years is that action has been at the national level. Policies have meant to apply across both A and B countries, even though the people living in those different places have wildly different values. This has long been the complaint of conservatives who desire for the federal government to stay out of their business, so that they can ban abortion or permit discrimination against minorities. Additionally, conservative states often want to be left out of various programs that involve the government intervention in various aspects of life. This preference for strong federalism has been resisted by Progressives who have wanted their policies to apply across the country.
The resistance to strong forms of federalism makes perfect sense in clear cases of injustice. Progressives cannot permit the widespread discrimination against minorities or the denial of basic rights to occur anywhere in the country (though there is also conflict about what should be considered a “basic right”). However, I think there might be a different story for positive programs, like the provision of universal health insurance. It may be possible for states in the A-country to undertake such programs themselves, much like Massachusetts did in the 2000s, but as a block. This might be in the form of a single market between states for health insurance (providing more competition) as well as the provision of common regulation and subsidies for that market (providing benefits of scale in implementation), or even a single-payer health system shared by those states.
The single-payer system may be especially interesting, because it would provide these states (which have a large proportion of the national population) substantial leverage to negotiate prices. It would also seem that this may not violate any constitutional restrictions on limiting federalism (a problem with Trump’s “plan” for the interstate sale of insurance), because it would be formed through the voluntary agreements between states. Multi-state agreements like this are not uncommon (port authority and transportation authorities, for instance), though this would be far more ambitious.
There are obvious difficulties to coordinating such a system, but I think it could be done if some of the larger or adjacent states (centered around California and New York, for instance) took the lead. If large states formed such a block, then the inevitable taxes required to pay for insurance subsidies would not render those states uncompetitive relative to others. Businesses to not routinely move from California or New York to Texas simply because of small differences in taxes (which already exist). The benefits of these locations are too enticing. Such a program could provide the benefits of the Affordable Care Act without the necessity of dragging unwilling states into the mix. There is a hope that voters in B-country would eventually see the benefits of such a social welfare program and want to be included in the interstate agreement. This may eventually grow into a truly national program once a critical mass of states agree to join. Of course, it is possible that majorities in B-country will never come around. All the worse for them, but it is not the fault of those living in A-country that those living in B-country are backward looking rather than Progressive.
Some will rightly worry that such a program would create a further rift in our country. Perhaps. Though in many ways that rift already exists. People in A-country and B-country already live in rather different worlds. And voluntary interstate agreements would eliminate the high levels of conflict that exists at the federal level; there simply would be less to argue about. The hope is that this would lower the stakes of federal policy formation, and thus make our politics more functional. Progressives will have an easier time convincing New Yorkers and Californians to implement such a program than convincing a block of former slave states.
*Completely unrelated note*: Kahn’s idea (From On Thermonuclear War) was something like the following. Even if our major cities like New York and LA (A-country) were blown up in the first round of a nuclear war, we might still have a substantial supply of infrastructure, resources, and people left. This “B-country” might include exciting places like Winona or Cedar Rapids. He thinks that we should plan on a strategy for an extended but winnable nuclear war rather than simply “mutually assured destruction.” But please don’t tell this to Trump. Especially because Kahn wrote this before larger stockpiles of hydrogen bombs existed, so his insight may no longer be relevant.