Canada did not establish its national health care program with a bold, immediate political move by the federal government.

    The initial progress came at the provincial level, led by the Co-operative Commonwealth Federation's Tommy Douglas when he served from 1941 to 1960 premier of Saskatchewan. The universal, publicly-funded "single-payer" health care system that Douglas and his socialist allies developed in Saskatchewan proved to be so successful and so popular that it was eventually adopted by other provinces and, ultimately, by Canada's federal government.

    For his efforts, Douglas would be hailed in a national survey as "The Greatest Canadian" of all time. But Douglas' regional initiative also offers a lesson for Americans.

    Those of us who know that the only real cure for what ails the U.S. health care system is a universal public plan that provides health care for all Americans while controlling costs recognize the frustrating reality that there are many economic and political barriers to the federal action that would create a single-payer system. This makes clearing the way experimentation at the state level all the more important.

    And, remarkably, the forces of real reform have won a congressional victory on that front, a victory that ought not be underestimated.

    By a 25-19 vote, the House Committee on Education and Labor on Friday approved an amendment to the House's health-care reform bill allowing states to create single-payer health care systems if they so choose.

    "There are many models of health care reform from which to choose around the world – the vast majority of which perform far better than ours. The one that has been the most tested here and abroad is single-payer," explained Congressman Dennis Kucinich, the Ohio Democrat who proposed the amendment. "Under a single-payer system everyone in the U.S. would get a card that would allow access to any doctor at virtually any hospital.

    Doctors and hospitals would continue to be privately run, but the insurance payments would be in the public hands. By getting rid of the for-profit insurance companies, we can save $400 billion per year and provide coverage for all medically necessary services for everyone in the U.S."

    Votes for the amendment came from progressive Democrats who favor single-payer -- such as Congressional Progressive Caucus co-chairs Lynn Woolsey, of California, and Raul Grijalva, of Arizona -- as well as conservative Republicans who have no taste for single-payer but want states to be able to set their own agendas. Opposition to the amendment came mainly from Democrats such as committee chair George Miller, of California, who have resisted moves to create more flexible, innovation-friendly legislation.

    The Education and Labor Committee -- one of three in the House with jurisdiction over health care -- then apporved the amended America's Affordable Health Choices Act, H.R. 3200, by a vote of 26-22.

    The campaign for to add the amendment was advanced by a number of groups, in particular Progressive Democratic of America, which mounted a last-minute campaign to sway Democratic members of the House committee. PDA Tim Carpenter is right when he says:

    "This is a victory for single-payer advocates. Our job in the ensuing weeks will be to ensure that this amendment does not get stripped from the final legislation." And they will have powerful allies who will fight to preserve the amendment.

    After the committee vote, Rose Ann DeMoro, the executive director of the California Nurses Association/National Nurses Organizing Committee, said, "This is a historic moment for patients, for American families, and for the tens of thousands of nurses and other single-payer activists from coast to coast who can now work in state capitols to pass single-payer bills, the strongest, most effective solution of all to our healthcare crisis."

    De Moro gets it.

    Allowing states to do what is necessary to provide high-quality yet affordable health care for all -- even as a federal plan falls short of that goal -- opens up vital new avenues for promoting, and actually implementing, single-payer systems.