> Using policy to mitigate social problems does seem to work well at the state level (for any given problem there seems to always be a state that's doing a good

> Using policy to mitigate social problems does seem to work well at the state level (for any given problem there seems to always be a state that's doing a good job tackling the problem) In the case of healthcare, the coverage standards, cost controls, revenue collection and payments must be handled at the federal level, otherwise you will end up with huge differences in benefits between state programs, which will result in similar issues seen with insurance companies today. For example, today, insurance companies are often loathe to pay for expensive-upfront but cheaper long-term procedures because the typical time for customer retention is correlated with how long their customers stay at their job. They don't want to pay for the procedure that their competitor is going to get the cost savings from down the road. There is nothing to stop an unregulated US-state run universal health system from doing the same thing. Also, because US states by definition have open borders, it would encourage health care arbitrage in densely populated border areas, which would overstress the systems of states with better health coverage, leading to inevitable legal conflict between those states. This is not to say that states can't play a role in the day-to-day local administration of healthcare benefits - just as they do with Medicare today - but the baselines have to be defined at a federal level.