Democrats are leading the moral and practical charge to get South Dakota to accept the money-saving, life-saving Medicaid expansion offered by the Affordable Care Act. Republicans are dragging their feet, claiming oh-so-cynically that they want to take their time and study the issue thoroughly before passing policy (something we only hear when they don't like a proposal).

Memo to Rep. David Lust, Governor Dennis Daugaard, and other balky Republicans: smarter people than you and I have already studied the Medicaid expansion. They've found the ACA Medicaid expansion will save states money. It will expand access to mental health services. It will do good. Do it.

Extra memo to GOP obstructionists: more government-run health insurance would use resources much more efficiently than the private insurance system, says Robert Reich:

...we’d do better to open Medicare to everyone. Medicare’s administrative costs are in the range of 3 percent.

That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare [Robert Reich, "The Hoax of Entitlement Reform," blog, 2013.01.06].

Reich notes that 30 percent of all spending in America's health care system is waste. Moving more people to the big pool of government health insurance could provide the leverage necessary to negotiate more of that waste out of the system.