comment: >
  
  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.
context: It's the same tax increase whether it happens at the state or federal level.