I think it would be very difficult to pull this off on a state-by-state basis, because an effective insurance system depends on economies of scale. We have an

I think it would be very difficult to pull this off on a state-by-state basis, because an effective insurance system depends on economies of scale. We have an individual insurance mandate in Massachusetts, but we also have all these teaching hospitals and we used to have a glut of hospital beds; the same kind of system would never have been able to work in, say, Alabama.