Correct. The only reason a state can't execute the plan is that the bulk of the heavy lifting has to be done on the cost control side which is interstate commer

Correct. The only reason a state can't execute the plan is that the bulk of the heavy lifting has to be done on the cost control side which is interstate commerce. Hell, an individual city or even neighborhood could create an insurance pool if it was affordable. Healthcare is not a financing problem or an insurance/risk pooling problem, it's almost entirely a cost control problem.