comment: >
  
  Are you suggesting that the government should not offer any public services because maybe Republicans will control it when they're in power?
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. >
  
  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. >
  
  Easy fix. Require them to have resided in the state for a fixed amount of time before being eligible. Nobody is going to live in expensive California for 5 years just to be eligible for benefits >
  
  This is only acceptable if you don’t lose coverage when you change states >
  
  That’s a great point. I didn’t think about that. >
  
  A major factor is budget concerns as state governments cannot run deficits in the same way that the federal government can. States are restricted in their ability to spend money in ways that the federal government is not. >
  
  The other thing is that a huge benefit of single-payer healthcare is the incredible position in price setting for drugs and medical procedures - effectively complete cost control. When done federally, its basically turning medical pricing over to the government. The problem with states doing it individually is that they don't have the same negotiating power as a national plan would. Now, it would be doable with the big four states - California, Texas, New York, and Florida - but just about any other state would struggle. Its just a higher price to pay at the state level in general due to the weakened ability to control costs. >
  
  The hive disadvantage is that the next time Republicans get into power they will be in charge of your healthcare. How you don't want additions, birth control, hrt or transiting in general, vasectomy, tubes tied, basically anything to do with family planning, or anything else the religious right is against. How anyone can go through the trunk years, including two where the GOP had the trifecta, and think "not o wish they had more control in my every day life."