Assuming that, like the Canadian system, there were a minimum Federal standard, it's certainly possible. Here are some of the issues that we'd likely have to deal with:
- What would be the states' financial obligations and to what degree would that lead to poorer or less healthy states' offfering much more restrictive benefit packages.
- How would we handle interstate movement? Would we have to dis-enroll and re-enroll? How would we handle families with multi-state legal residences? If we were using some form of voucher program, this would likely be even worse because different states might authorize different health plans.
- How tolerant would we be of the extra complexity? In contrast to our 50 states and a few other jurisdictions, Canada has 13 provinces and territories.
- Are the risk pools in smaller states smaller than we'd like? Canada seems to do OK, but I don't know how they deal with this or if they equalize the load in any fashion.
And Neil's question raises more questions to which I don't have the answer (yet). They include:
- How does Canada handle its territories, especially those with very small populations? The Yukon barely has 30,000 people. Nunavut has less than that.
- How do they handle interstate movement?
- What are the provincial financial obligations?
As noted earlier, this assumes there were a minimum Federal standard. If there weren't, you'd run into all kinds of extra problems, especially serving as a magnet for high cost patients. Over the past few years, there have been several states that have considered some form of state-only single-payer system. Vermont and California are considering them now. It strikes me as asking for trouble, but perhaps, if it relieved employers of the financial burden of paying for health benefits it would also be a form of economic development. Hmmm. That's actually worth analyzing.