Yuval, I’m for health-care federalism too. But I think we have different ideas of what that means. You write: “Conservatives have not always been enthusiastic about health care federalism because they want to enable Americans to buy insurance across state lines, and so to avoid benefit mandates that make insurance extremely expensive in some states.” But letting people choose which state’s regulatory regime they want to operate under is a kind of federalist policy. It is the same sort of competitive federalism that we apply to many other areas of policy, notably corporate law. It is, for example, more federalist than imposing deregulation by direct federal decree. (Federal law does this already in some respects, exempting large employers from states’ mandates; and many conservatives have sought to grant similar protections to small employers who band together.)

I disagree with your Standard article, meanwhile, for a different reason. James Capretta and you wrote, “Because the Medicaid program is mostly run by the states but largely funded by the federal government, states seeking to innovate almost always need federal approval for their plans. . . . The most constructive role the federal government can play in helping provide greater and more stable and portable access to private insurance in the coming years would be to extend such waivers more broadly, or, through legislation, to remove the need for waivers altogether.” I have no objection to letting states implement any health-care plan they want, so long as they raise the money for it themselves. But letting them make their citizens more dependent on the taxpayers of the other 49 states isn’t federalism as anyone would have recognized it in the first 150 years of our national life. State flexibility is a large part of what has given us the Medicaid cost crisis.

So, in short, I think you misclassify one policy (interstate freedom of commerce) as anti-federalist while misclassifying another (Medicaid waivers) as federalist. Other than that, we agree. . .