Here is Ezra Klein bashing Romney and the notion of advancing health care reform at the state level:
‘This federalism stuff isn't just a Romney idea, though. The late, great, Paul Wellstone championed this strategy from the minority, and Russ Feingold has carried it through the recent Democratic resurgence, attracting Republican co-sponsors like Lindsey Graham along the way. Liberal organizations like the Progressive States Network back this approach, and they've attracted some strange bedfellows, including Stuart Butler of the Heritage Foundation. "Let's just try many different approaches in many different states and see what happens," he tells me. "The more complex an issue is, the less possible it is to actually know the best system in advance -- therefore a system of trial and error in which all these pieces work together is the best way to push forward."
Under this vision and its many variants, the federal government would set certain minimum coverage and insurance standards that each state would have to meet, guarantee set levels of financing, and allow 50 beautiful flowers to bloom. In liberal versions, the standards would be stringent, forcing comprehensive care and universal coverage. In conservative visions, like Romney's, the states have considerably more autonomy to do nothing.”’
I think to some extent Ezra is missing the point behind a state based approach which is trial and error. This is how we arrived at Welfare reform which was modeled after the Wisconsin Works program and has been hugely successful. But the presumption is not that “50 flowers will bloom”, rather that some will and some will not giving us an idea of how to best pursue action at the federal level.
Do read it as he has some great points.