LEAVING HEALTH CARE TO THE STATES WON’T WORK…. It may be tempting to think that structural changes to our dysfunctional health care system shouldn’t come from Washington, D.C., at all. Why not let the states deal with the problem? Haven’t some states — Massachusetts, Hawaii — already taken some positive steps on their own?

Alec MacGillis had an important piece the other day, explaining why a state-by-state approach won’t help. Part of the problem is discouraging but unavoidable: most uninsured Americans live in conservative states where policymakers have no interest at all in improving the failing system.

Supporters of a national approach counter that relying on states would mean accepting the status quo for years to come. A state-by-state approach makes it harder to rein in health costs with systemwide reforms. And cash-strapped states are in no position to launch new initiatives. […]

And even in brighter times, the states with the highest rates of uninsured — mostly in the South and West — have shown little interest in expanding coverage.

“There just isn’t the political will” in many states, said Jon Kingsdale, who runs the agency overseeing the Massachusetts health-coverage program. “To leave this to the states is not realistic — it’s what we did for the last 40 or 50 years.”

By any reasonable policy standard, expecting states to tackle the problem has it backwards. States, which must maintain balanced budgets, are currently reducing coverage, just when families need the most help, as state and local governments find themselves in weaker financial positions.

Even as the economy improves, conservative states like Texas — home to 6 million uninsured, the worst rate in the country — reject improvements to the system on ideological grounds. It’s not an accident that the most conservative states are already home to the highest rates of uninsured — those are the states already predisposed to ignore the problem.

A few years ago, the Monthly published a helpful piece on this by Ezra Klein, and its arguments are just as compelling now as they were at the time.

If the dysfunctional status quo is going to be improved, the change is going to have to come from Washington. And if it’s going to come from Washington, it’s going to have to happen soon. And if it’s going to happen soon, congressional Democrats — who’ve already approved a reform bill in the House and Senate — are going to have to finish their work and take advantage of this once-in-a-generation opportunity.

Pass. The. Damn. Bill.

Steve Benen

Follow Steve on Twitter @stevebenen. Steve Benen is a producer at MSNBC's The Rachel Maddow Show. He was the principal contributor to the Washington Monthly's Political Animal blog from August 2008 until January 2012.