Though I have plenty of problems with the Massachusetts health reform legislation, I really do think that it is important to maintain distinctions between state and federal programs. Kim Strassel writes,

Mr. Romney has at times put forward selective data suggesting the program’s costs aren’t exploding. At other times he has complained his state hasn’t done enough to control costs. By October of last year he was arguing on CNN that “We . . . didn’t have any pretense we would somehow be able to change health-care costs in Massachusetts.” This, despite promising in 2006 that under his plan “the costs of health care will be reduced.” Through it all, Mr. Romney has never backed away from his individual mandate, which requires people to buy insurance or pay a fine. Yet Republicans and independents despise the mandate, with many believing it is downright unconstitutional. Mr. Romney’s subsidized coverage is meanwhile doing what entitlements do: crowding out private insurers, compounding the cost explosion, walking the state toward rationing. So long as the former governor clings to these central points of his health plan, he’s on the wrong side of free-market policy and public opinion.

Are there Republicans and independents who believe that the Massachusetts mandate is unconstitutional under the constitution of the Commonwealth of Massachusetts? That is the relevant question, and I think the answer is no. The beauty of a federal system is that states are allowed to pursue their own understandings of what constitutes sound public policy. The Massachusetts health system is in need of reform, and one assumes that we will see further consolidation of health providers and, one hopes, the emergence of new low-cost providers.

But again, it is entirely consistent to favor a state system built on a strong individual mandate and oppose such a system at the federal level. If Romney does indeed run for president in 2012, and his success during the Brown campaign suggests that he learned a great deal from his last foray in national politics, I certainly hope that he runs as the candidate of a renewed federalism.

While some on the left believe that a federal polity is an outmoded idea — better to build a highly centralized state along the lines of Napoleonic France — I tend to think that rapid technological and demographic change only reinforces the case for more nimble, flexible, responsive governments that navigate between the need for economies of scale and the pitfalls of diseconomies of scale. It is certainly true that we’ve allowed our federal system to fall into a trap of institutional isomorphism and excessive overlap of responsibilities between the state and federal governments. That must be fixed, and it can be fixed if we can make an effective political case for doing so.

The drift now, of course, is very much in another direction.