Health care. We lost.

Sometimes, the good guys lose.

We lost this one. We're no closer to universal good enough care than we were four years ago. Maybe further.

It was close. In retrospect, with perfect knowledge, there were alternative routes that might have worked. The route we took had too many opportunities to fail.

I'm saddened, but not surprised. I thought the quality of discussion during the failed Clinton reform was poor (for which I blame Hillary actually), but it was golden compared to this go round. The vast majority of educated middle class Americans had absolutely no idea what was going down. No idea ... and little interest. Without that core support the politics were awful.

So what happened to the educated middle class? Age is a part of it. We're an older, graying, fear-filled nation in transition. The boomers imagine medicare will be there, and gray American hates change.

The collapse of the fourth estate was another contributor. In the 1980s media coverage of the Clinton plan was superb; twenty years later it was almost worthless. It was easy for a fearful, sclerotic, population to stop paying attention.

Above all, though, I finger the same mixture of complexity and corruption that led to the Great Recession. We're paralyzed.

So now what?

It goes to the states. The only congressional action that would help at this point would encourage states to experiment widely and to create inter-state health care plans.

At the state level, I expect real change to come under Republican governors. Only Nixon could go to China, and perhaps only GOP governors can transform American health care.

So maybe losing isn't all bad. I've long believed achieving affordable universal health care in America would require the same kind of massive disruption that destroyed General Motors. That kind of disruption is not politically feasible; but markets will do it. The best GOP governors are capable of wedding the destructive forces of markets to socially desirable outcomes. That's the path that's left to us now.