I think it would be better but it still doesn't address the problem of easy money making everything expensive. The other problem I think could come from making each state a "walled garden" so to speak that prevents non-residents from using those services. At least with the states deciding you can vote with your feet.

I could see California residents arguing why they should pay for the medical expenses of tourist.

Having some domain specific knowledge of the financial flow through the industry, I tend to favor a more federated administration model like you suggest. Skeptical of federal level ability and historical competency, I favor outsourcing the initial transition wrt implementation and administration to Switzerland, Netherlands, Singapore, France, etc.

Now that I have thought about it for a little while longer I think I would be fine with each state deciding which model they wanted to follow. I falls in line with states rights and the 50 individual experiments concept. Which I also believe in. If one of the models work then great. If not they can look to see what is working.