One of the ideas of the country is that each state should be treated as, more or less, its own largely sovereign state. Federalism has it that the central government takes dominion over international affairs and, otherwise , only has a small part to play in interstate commerce or other domestic issues.
Despite desires to the contrary, that’s still largely true and the focus on the President and Congress by the general public is unbalanced relative to how important the Federal government is to them. The post office just isn’t an integral part of most people’s day.
More importantly, the general expectation would be that each state figure out it’s own stuff and develop its own character and concerns.
If a state wants to offer a deep and generous social welfare system, then it should do so - based on the elected representatives of the local populace having decided that it matches the state’s ethos. If the local culture is “from one to all”, they should do that. Or if, on the contrary, it’s “each man for himself”, then so be that.
In general, we should have 50 different systems, all being tested out and trialed.
Really the question isn’t what any one of those should be - maybe one state would do as you suggest - it’s why each of the 50 states is completely ignoring their own sovereignty and trying to push the issue to the Federal government.
Personally, I suspect that the parties have decided that wrangling over this and other intractable “centralized government” issues 1) helps to drive money to the national party and, subsequently, the party has more motivation to ignore working on these problems at the state level, and 2) any politically sensitive issue, poorly done, risks significant political backlash. If you can push it to the Federal stage then it’s someone else’s problem and, there, Constitutional limits against the Federal government form a built-in blockade against any actual implementation. The parties are naturally protected from having to actual do something and thereby risk completely flubbing it.
In general, politicians would rather seem to be doing something than actually do it. Our current election system selects for natural yes men. Yes men are, generally, just not people with big ideas of their own. And they don’t feel competent to do the complicated work that we’re asking them to do.
So like I said, how to actually organize health care is a much smaller issue to the question of how to get it so we can actually get movement on health care. That probably won’t happen without revisions to the electoral system, to encourage people of substance to get into government.
Otherwise, we might as well suggest that our healthcare system include free rides to the Moon and a slice of cheesecake for all that it really matters. The focus by the general public - like most of the people on this forum - on which system to choose, how to finance it, etc. instead of the question of why there’s been no movement in decades despite our system clearly being worse than pretty much every other option that anyone could come up with, is what keeps us from getting a better system.
As an engineer, you don’t ask, “What’s the coolest bridge?” You ask, where do I get workers, what materials can I use, what’s my budget, what are the predominate natural disasters in the region, etc. Building the bridge is a relatively small concern relative to the “how” - the basic foundation of moving from a desire to an actual product.
That foundation is missing, and everyone’s too busy dreaming up their perfect bridge to notice that there’s no raw materials.