comment: >
  
  A few reasons come to mind:
  
  States can't spend as much money as the federal government -- many can't go into debt and are forced to balance the budget. Spending would vary in volatile years, and probably most so in the first few years as things adjust. (Going into debt is worthwhile if the early costs will provide greater savings/growth in the future, which a healthy and secure workforce definitely does).
  Part of the advantage of a federal single-payer system is using such a massive customer base as leverage with pharmaceutical companies and medical service providers to negotiate prices. That's how costs are reduced. Most states are too small to pull that off on their own.
  A lot of the laws/regulations that would helpthe single-payer system work might not be legally feasible at the state level, e.g. any impact on interstate commerce would run afoul of Congress' privileged position.
  Even what laws and regulations states are allowed to enforce would vary between states, and could just make health care more expensive as companies need to hire an army of paper pushers to navigate the complex legal jungle.
  
  It's sort of an all-of-us-or-none-of-us situation. An elegant, nationwide system will definitely work. A smaller, state-specific system would be significantly more difficult to pull off, if at all. And a shared system between a coalition of states would probably get sued out of existence by corporations, or even the federal government. Of course, Congress could even pass a law forbidding it.
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." >
  
  Are you suggesting that the government should not offer any public services because maybe Republicans will control it when they're in power? >
  
  Never give the government power if your political enemies will also be able to wield that power >
  
  I think the other is just bemused by the idea that we shouldn't let the government provide universal healthcare at all because it might one day provide less than it did.
  Like, if we can get it to 80%, but we worry it might drop to 60%, that's still 60% more than 0%. >
  
  I think it's less about that and more about what medical procedures become legal or illegal based upon who is in power and whether or not you want government dictating what kind of medical treatment is available to you >
  
  That has nothing to do with government funded healthcare. In fact, the government already outlaws certain procedures based on conservative ideology. Just look at what's happening to trans people across the country. Doing good things isn't going to make them more able to do the bad things they're already doing >
  
  
  That has nothing to do with government funded healthcare.
  
  The above poster didn't say it correctly (legal vs illegal), but the point is correct. If the government is the sole provider of healthcare payments, if they say they won't pay for something, it is essentially banned. This isn't hypothetical either. The Hyde Ammendment is a law right now that prohibits the federal government from paying for abortions. M4A plus Hyde = no abortions. Nationwide. Now apply that to anything else the religious right doesn't like. 
  If you don't trust Trump and McConnel to decide what is and isn't healthcare, you should oppose M4A. A public option gives healthcare to people who need it, without forcing anyone onto a government run plan. >
  
  
  If the government is the sole provider of healthcare payments, if they say they won't pay for something, it is essentially banned
  
  That's not how public healthcare works at all, nor is it at all what is being proposed. >
  
  So Massachusetts has Romneycare, which is a hybrid system that is what the ACA is based on. Under Massachusetts, law all residents of the state have to be fully covered with health insurance. How it ends up working is that most residents receive health care through their employers. Those whom are not offered health care through their job or make under a certain amount are eligible to sign up for mass health, which is the safety net system that covers all of those without insurance. Mass health is basically a combination of medicaid and chip with the program extended through state funding to cover the underinsured. >
  
  NJ implemented a similar system during the pandemic. >
  
  ummm, APM is the best short to medium term solution and is a success, Even in Vermont
  
  Statewide, the VTAPM achieved statistically significant reductions in cumulative gross ($782.58 PBPY;
  -6.8 percent) and net ($748.74 PBPY; -6.5 percent) total Medicare Parts A and B spending (see Exhibit
  ES.3). When including first three quarters of PY3 (2020), we observed significant reductions in gross
  spending ($921.34 PBPY; 8.7 percent) and net spending ($876.62; 8.2 percent). >
  
  Vermont tried Single Payer legislation kinda like M4A and it failed, Taxes were to high 
  But Vermont, and Maryland have instead used the current system to atleast reduce healthcare spending in the state through All Payor Model where costs are controled through rate setting
  
  An all-payer model agreement is a system where a service or treatment costs the same for every patient under the same provider, no matter what insurance
  
  
  Hospitals used rate adjustments to remain within their budgets. Hospitals regularly monitored their volume and adjusted their rates during the year to meet budget targets. 
  the number of
  hospitals with rate adjustments above 5 percent was largest in the last quarter. This pattern is
  expected if hospitals adjusted their revenues at the end of the year to meet their budget targets. 
  frequent rate adjustments could negatively affect uninsured patients who
  pay for their services out-of-pocket. Although patients with insurance had limited cost-sharing
  liability, individual patients who were uninsured might face different out-of-pocket costs
  depending on when they received services. 
  Inpatient revenues decreased as a share of hospital revenues, while
  outpatient revenues increased after starting the  All-Payer Model.
  This shift from inpatient to
  outpatient services is consistent with hospital efforts to move unneeded care out of the inpatient
  setting to lower-cost, outpatient settings. These changes, however, may reflect broader national trends led by market costs rather than a direct response to the All-Payer Model
  Maryland Medicare admissions with major or extreme severity of illness declined by 13.2
  percent relative to the comparison group. This decline suggests hospitals may have
  responded to global budgets by controlling the intensity of resource use during an
  admission for the sickest beneficiaries. This may not have been the case for commercial
  plan members as the percentage of commercial admissions with an intensive care unit
  (ICU) stay declined 6.8 percent less in Maryland than in the comparison group. >
  
  I think the biggest factor is actually negotiating power over prices.
  As long as it’s one state, or five or twenty, they will have to operate under the current system of private insurance and pharmaceutical companies. Pharmaceutical companies and other medical providers will, as they do now, negotiate prices well in excess of what is paid by countries with nationalized health programs. You need to nationalize to change the actual economic forces that create $60 charges for two Tylenol and the whole negotiated price nonsense where providers have to literally haggle with the insurance company. >
  
  This is one small but crucial piece of a large and complex problem. >
  
  The logistical headache this would create would be astounding. Going from state to state isn't like driving from one side of Europe to the other; you don't need a passport, you're not encountering separate courts and systems of law, you don't need visas. You can pick up and just move one day, no questions asked. Simply file a form with the post office that says you're moving, and the rest of the state's documentation can come later. 
  Imagine a world where California implemented a policy for UHC, but they were alone in doing so. And hypothetically, let's say you have a couple in Missouri who've just discovered they are pregnant. They could move to California and establish a full 6 months of residency, just to get Cali to foot the bill for the delivery and hospital stay, then fuck off back to Missouri. They are the only ones in this scenario who come out on top: the California government would be subsidizing the healthcare of essentially residents of another state, would not collect enough taxes from that couple over the course of their residency to even out the cost, and ultimately go heavy into the red as a result of just one procedure. The nurses & doctors in the now-state-run hospitals would almost certainly get overworked and underpaid...so no change there except they now get more overworked and less paid. Missouri hospitals lose out on the revenue from the birth, and so on.
  Now, does this mean that UHC is a bad idea, or an untenable one? NO. It's still by far the most humane way to treat your citizens' health, and pays dividends into the future. But it does mean that any state which leads the charge on this is dooming itself to massive financial struggles, not to mention the loss of the for-profit healthcare companies who generate tax revenue for setting up shop there. It's a prisoner's dilemma: he who goes first takes on all the water, and even though that might make future states more interested in following suit, more likely they'll just nuke their own state budget and face major unrest over it. >
  
  
  Going from state to state isn't like driving from one side of Europe to the other; you don't need a passport, you're not encountering separate courts and systems of law, you don't need visas. You can pick up and just move one day, no questions asked.
  
  Most of Europe already has free movement with no visas. The Schengen Area has a population far larger than the United States. >
  
  If you're from the UK and use the NHS as your primary means of healthcare and are hit by a bus in Germany, who foots the bill? The NHS? >
  
  Ah! I appreciate the information.
  Now, if we apply it to the United States, such a thing might be 1:1 applicable if we were more strict on state residency and enforcement of it - which, to be clear, I'm not in support of. I'd rather it be federal and be done with it. >
  
  You can't have state residency requirements.
  Shapiro v. Thompson (1969) and Sáenz v. Roe (1999) have already determined state residency requirements for welfare benefits to be unconstitutional impediments to US citizens right to travel to other states. >
  
  So then federal is the only way to do it? >
  
  Most of the Medical in the US is Scheduled.  Its calling a doctor and getting accepted.  
  
  There was almost 1 billion Doctor Office visits in the US and 1.3 Billion scheduled surgeries in the US compared to the 139 million ER Visits
  
  Over half of the ER VIsits are insured patients visiting the ER instead of waiting for a Doctors visit 
  According to UnitedHealth Group research, two-thirds of hospital ER visits annually by privately insured individuals in the United States – 18 million out of 27 million – are avoidable.
  An avoidable hospital ED visit is a trip to the emergency room that is primary care treatable – and not an actual emergency. The most common are bronchitis, cough, dizziness, f­lu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection. >
  
  States don't have enough money to finance public healthcare.  Even wealthy states like California that post positive budgets in the hundreds of millions just don't have the money to pay for everyone's healthcare.
  The only way to make it cheap and fair for everyone is to have the federal government do it. >
  
  that’s why the people pay for the healthcare through taxes >
  
  An individual state doesn't make enough in taxes to pay for healthcare and also provide other basic services its people need, such as firefighting, road repair, schools, libraries, etc.
  The only U.S organization that can afford to drop that much taxpayer money on healthcare is the federal government. >
  
  What you are saying is that if individual state increases taxes to the level of federal taxes, then they can pay for it. >
  
  Why burden an individual state's taxpayers with additional taxes when the federal government already has the resources? That would be a silly thing to do. >
  
  "Why" is a different question. It is important to understand it is possible, and what are pros and cons of that. Saying "it's impossible" is false and does not allow to perform pros-cons analysis. >
  
  This would have been a lot more plausible and was floated as an idea before the SALT caps were put in. Now for a state to do it there would be a high degree of double taxation.
  Any move for state funded universal healthcare would have to be coupled to a SALT cap repeal at the federal level. >
  
  Altering SALT caps rules to create exception and allow to deduct in-state healthcare taxes from the federal taxes could be a way to federally fund UHC without federally implementing UHC. >
  
  I'd +1 to that, much more paletable than a full repeal of the cap. >
  
  MD poured a bunch of money into the market a few years ago. My premiums on the market went from 1100 to 700. I didn’t qualify for reduced amounts. I am now on Medicare. MD tries and that was even under a rep gov. The way it is Aetna doesn’t offer marketplace because they can’t make quite as many millions. At the time it was BC and Kaiser