Under the coming administration and Congress, the repeal of the Affordable Care Act (Obamacare) looks like a foregone conclusion. What's a nation to do? If the federal government is going to drop the ball, the states will have to pick it up. One possibility is for progressive-leaning states that favor single-payer to band together to create it for themselves.

Here's one way it might work: California, Washington, New York, New Jersey, and Massachusetts form the core. That's roughly 75 million Americans, or close to 1/4 of the population. These states would enter into an interstate compact to join their populations into a single, unified pool and create a single-payer healthcare system to serve their residents. Other states can choose to enter the compact at a later time if they meet the requirements (whatever they may be).

Our Constitution states that Congressional approval is required to create an interstate compact, but the Supreme Court has decided (Virginia v. Tennessee) that only agreements that shift power from the federal government to the states require approval. I am not a lawyer, but it seems possible to create this compact in a way that does not require approval.

Benefits of this approach:

Statistics show that blue states tend to be healthier than red states. Our combined pool would be healthier than the national average, so we would pay less than if it were a national program. We can keep more of our taxes for our own benefit. Blue states also tend to contribute more to federal taxes than we receive in federal funding for programs - a net loss for us. Now, remember that you don't have to pay tax on taxes, so you get to deduct state tax payments from your federal taxable income. If this system was funded by a progressively structured increase in state income taxes, more of our taxes would flow to the states and less to the feds. This has the bonus benefit of depriving the feds of tax revenues, and could hamper their efforts to establish programs detrimental to America in general or the residents of blue states specifically. Yes, this is a kind of economic warfare, but it wouldn't be us firing the first shot.

Pipe dream or an idea worth considering?