comment: >
  
  One thing you're not considering here is that if Blue states try to do this, it'll create an adverse selection pool. People who are likely to accumulate significant medical bills will move en masse to states with universal care, and healthy people who don't want to pay for universal care would be incentivised to move out of those states. For universal coverage to work, it needs to be nationwide.
context: It's the same tax increase whether it happens at the state or federal level. >
  
  Not necessarily. The federal government already runs the largest payer on the planet that has a billing system built into every provider operating in the country. CMS operating a universal healthcare system will be way cheaper than Vermont's effort with Green Mountain Care.
  For example, Vermont acts as the primary payer to about 182,000 Medicaid enrollees in the state. CMS covers 65 million people. >
  
  Don't forget the VA healthcare system with its more than 9 million U.S. veterans who are currently enrolled in the VA and eligible to receive health care. >
  
  ... and there's the funny thing about the US healthcare system. The US already has every kind of health care system in place today. By my rough reckoning the US payor landscape looks a bit like this:  
  
  Beveridge model - VA, DoD, IHS
  Bismarck model -> US group health market, Tricare, Medicare Advantage
  National health insurance model -> Medicare, 52+ versions of Medicaid/CHP  
  Uninsured model -> Uninsured 
  
  It's a touch unsurprising that the market is bananas when you have 52+ markets for health insurance, and then you carve up those markets even more with different models of care.