Of course, the comparative wealth of blue states and the relative poverty of red states has a lot to with it, too.

That's especially the case with federal education aid to reliably Republican redoubts, even if conservatives are loathe to admit it. That dynamic came to the fore during the 2011 battle in Wisconsin over collective bargaining rights for public employees, including teachers. The right-wing blogosphere made the mistake of complaining that Wisconsin received millions of dollars in federal education aid when solidly Republican red states get much, much more. Then, the Republican union busters whined that Badger state students can't read. As it turns out, Wisconsin students outperform their counterparts in those reddest of states where collective bargaining rights are few—or non-existent.

For example, Terence Jeffrey of CNS News protested that "two-thirds of Wisconsin eighth graders can't read proficiently." The implication, of course, is that the unacceptable scores are the fault of overpaid, undeserving public school teachers. Sadly for Jeffrey and his right-wing echo chamber, the data show that Wisconsin schoolchildren out-read the kids in states where Republicans poll best and public workers have the fewest collective bargaining rights. Those know-nothing red states also happen to be where the federal government most heavily subsidizes the local education systems.

The numbers—and the electoral map—tell the tale. According to the National Center for Education Statistics, Wisconsin does in fact spend more per student than some of its Midwestern neighbors even as its pupils score less well. But with 34 percent of its eighth graders students at or above the target reading proficiency, Wisconsin far outperforms the Republicans' solid south (and the national average of 30 percent). Only Kentucky, which receives substantially more money from the feds, can match Wisconsin's scores. Florida and Texas? Not so much.

Just as telling (as the table above reveals), the woefully inadequate per student spending levels are propped up only by generous federal spending provided by blue state tax payers. If anything, GOP bastions like Mississippi and Louisiana need more help from Washington, not less. Meanwhile, the bluest of states in the Northeast spend more and get what they pay for. In Connecticut, 43 percent of eighth graders are at or above reading proficiency. The Nutmeg state spends $14,610 per pupil per year. New Hampshire (39 percent, $11,951), Vermont (40 percent, $14,421) New Jersey (42 percent, $17,620), Pennsylvania (40 percent, $11,741) and Massachusetts (42 percent, $13,667) pay the price for better educational outcomes.

The same pattern holds for health care as well. In a nutshell, health care is worst in those states where Republicans poll best. And the good people of those states need help, whether their politicians want it or not.

That point was reinforced with a recent Gallup poll on the uninsured in America. With almost 28 percent of respondents uninsured, Texas far and away led the nation as well as the "uninsured belt" that stretches across the solidly red south. Led by Massachusetts, 9 of the top 10 performing states voted for Barack Obama in 2008.

But tallying up the ranks of the uninsured understates the magnitude of the unfolding health care horror story in Red State America. Two years ago, the Commonwealth Fund released its 2009 state health care scorecard, which measured performance in providing health care access, prevention and treatment, avoidable hospital use, equity across income levels, and healthy lives for residents. Again, while nine of the top 10 performing states voted for Barack Obama in 2008, four of the bottom five (including Arkansas, Mississippi, Oklahoma and Louisiana) and 14 of the last 20 backed John McCain. (That at least is an improvement from the 2007 data, in which all 10 cellar dwellers had voted for George W. Bush three years earlier.)

The "America's Health Rankings" project echoed those findings. And in 2009, another UnitedHealth Group funded study similarly showed that red state residents are the unhealthiest in America. With Vermont topping the list and Mississippi bringing up the rear, Americans would do well to listen to Dr. Howard Dean and not former Gov. Haley Barbour when it comes to the health care debate.

In May 2009, the Washington Post ("A Red State Booster Shot") explained how national health care form would ultimately have to work—and have to be funded:



Health-care reform may be overdue in a country with 45 million uninsured and soaring medical costs, but it will also represent a substantial wealth transfer from the North and the East to the South and the West. The Northeast and the Midwest have much higher rates of coverage than the rest of the country, led by Massachusetts, where all but 3 percent of residents are insured. The disproportionate share of uninsured is in the South and the West, the result of employment patterns, weak unions and stingy state governments. Texas leads the way, with a quarter of its population uninsured; it would be at the top even without its many illegal immigrants

Which is what came to pass. With the full implementation of the Affordable Care Act beginning in 2014, federal assistance to under-served red states will only increase. (Today, the federal government on average picks up 57% of the tab for Medicaid, with poorer states like Mississippi and Alabama getting 75% of their funding from Washington. Medicaid not only pays for a third of nursing home care in the United States; it covers a third of all childbirths. In Texas, the figure is one-half.) The coming expansion of Medicaid to families earning 133 percent of the federal poverty level (FPL) and the availability of subsidies to those at four times the FPL will enable coverage for over 30 million more people nationwide. (Of these, the Urban Institute estimated that 8.1 million Americans would have their insurance paid for in full by the expansion of Medicaid. Another 10.9 million people would receive subsidies to buy private insurance in the new state exchanges, while only 7.3 million, 2 percent of the total U.S. population, would be required to purchase a health plan using their own resources alone.)

All told, the nonpartisan CBO forecast the states would be on the hook for $60 billion in new costs over the first decade. As the Center on Budget and Policy Priorities explained:



Claims that states will bear a significant share of the costs of the Affordable Care Act's (ACA) Medicaid expansion -- and that this will place a heavy financial burden on states -- do not hold up under scrutiny. Congressional Budget Office (CBO) analysis indicates that between 2014 and 2022, the ACA's Medicaid expansion will add just 2.8 percent to what states spend on Medicaid, while providing health coverage to 17 million more low-income adults and children. In addition, the Medicaid expansion will produce savings in state and local government costs for uncompensated care, which will offset at least some of the added state Medicaid costs.

It's no wonder Ezra Klein called the Affordable Care Act "an incredibly, astonishingly, unbelievably good deal" for the states. Especially for the red ones:

Nevertheless, in the wake of the Supreme Court's health care ruling in June, many Republican governors declared they would fight to preserve their states' dismal health care systems. Louisiana's Bobby Jindal, who warned the "frightening" Court decision could lead to penalties for those who "refuse to eat tofu," insisted "we're going to do what we can to fight it." In Texas, a spokesman announced that Gov. Rick Perry "has no interest in fast-tracking any portion of this bankrupting and overreaching legislation." Rick Scott also said no nearly 1 million Floridians who would gain insurance, proclaiming that "since Florida is legally allowed to opt out, that's the right decision for our citizens." And in South Carolina, tea party darling Nikki Haley said of 330,000 potential beneficiaries in her state, "We're not going to shove more South Carolinians into a broken system." As Think Progress lamented:



Not a single Republican governor has pledged to accept the new Medicaid funds and three Democrats are also considering turning down the money. In total, these states would give up $291.4 billion in federal funds and leave 10,297,221 Americans uninsured.

"What I would do is keep--as we have today--state responsibility for those that are uninsured. You see I believe in the 10th Amendment. I believe the states have responsibility to care for their people in the way they feel best."

Letting states continue to take the lead would be disastrous, for one very simple reason: providing health care for all citizens is one of those tasks, like national defense, that the states are simply unequipped to manage on their own. The history of state health reform initiatives (and there's quite a history) is a tale of false hopes and great disappointments. The deck is stacked from the start, and the house--in this case the insurers, the providers, and other agents of the status quo--always wins....Over the years, states have tried programs of many different ideological and economic persuasions. All of them failed, and not because the programs were insufficiently inventive, but because states are structurally incapable of sustaining them.

"If ObamaCare passes, that free insurance card that's in people's pockets is gonna be as worthless as a Confederate dollar after the War Between the States -- the Great War of Yankee Aggression."

As it turns out, the Republican Party would make things worse where their strongest supporters reside. Presidential nominee Mitt Romney , whose own 2006 Massachusetts health care reform would have been impossible without expanded federal funding, has promised to repeal the Affordable Care Act, slash Medicaid by over a third and give the funds to the states in the form of block grants:Unfortunately, recent history shows that even relatively more affluent states have failed to deliver universal coverage when they try on their own. Writing for the Washington Monthly back in 2007 (" Over Stated "), Ezra Klein looked at the grim fates of efforts in California, Hawaii, Washington, Oregon, Tennessee and Illinois. Thanks to their small markets, limited resources, unique populations and unsustainability in the face of recession-induced budget cuts, susceptibility to recessions, he concluded "the laboratories of democracy' can't achieve universal health care":Especially in states home to representatives like Georgia Congressman Paul Broun . After all, it was Broun who took to the House floor just days before its passage to decry the Affordable Care Act that would help so many of his constituents:For Chuck Thompson , that kind of talk was the final straw. The author of the new book Better Off without 'Em: A Northern Manifesto for Southern Secession , Thompson argues that "We - meaning this group in the north as we might identify ourselves - could take the country we want into a direction that we think is befitting of America without this push and pull that comes from the Southern states. At the same time the South could do the same thing."

But even in jest, that cannot be the answer to our dissastified countrymen. That's just not the American way. After all, the Constitution still calls on us to "to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity" for all Americans, everywhere. Red states may be "takers, not makers" and leaders in just about every category of social pathology you can imagine, but that doesn't make their residents any less (or blue staters any more) American. Lincoln's calls to "the better angels of our nature" and for us to act "with malice toward none, with charity for all" was not a one-time request, but a continuing obligation. Americans everywhere should want Americans anywhere to have the resources for the education, health care and anti-poverty programs they deserve and may badly need. Even if some of their politicians say no to the help.

As for the red state socialists whose cognitive dissonance prevents them from acknowledging the flow of blue state dollars into their hands, I have only one request. Don't confuse losing an election with tyranny. Please drop the talk of secession, insurrection, "Second Amendment remedies" and watering the tree of liberty with the blood of patriots. When the American people through their duly elected representatives commit their combined resources to your aid, consider this response instead.

"Thank you."