Would State-Based Single-Payer Health Insurance Cure What Ails?

I analyze the barriers to establishing a state-based single-payer system in our federal constitutional system. In my opinion, only an improbable confluence of circumstances would allow individual states to go their own way with single-payer systems. At the national level, by contrast, a single-payer approach seems viable, but wouldn’t overcome all the problems inherent in insuring consumers who know little about the cost or value of health care services.