The legalization of gay marriage began in a few states and quickly became national policy. Could reforming health care follow the same trajectory? (Photo: Shutterstock)

Last week, California's new governor, Gavin Newsom, promised to pursue a smörgåsbord of changes to his state's health care system: state negotiation of drug prices, a requirement that every Californian have health insurance, more assistance to help middle-class Californians afford it and health care for undocumented immigrants up to age 26.

The proposals fell short of the sweeping government-run single-payer plan Newsom had supported during his campaign — a system in which the state government would pay all the bills and effectively control the rates paid for services. (Many California politicians before him had flirted with such an idea, before backing off when it was estimated that it could cost $400 billion a year.) But in firing off this opening salvo, Newsom has challenged the notion that states can't meaningfully tackle health care on their own. And he's not alone.

A day later, Gov. Jay Inslee of Washington proposed that his state offer a public plan, with rates tied to those of Medicare, to compete with private offerings.