But I'm not convinced that it's a total explanation, either. Necessary but not sufficient.
Like you said, small countries already do this. When 2/3 of the states can agree on a system then we make it federal. This is more like what Sweden does, their counties finance and administer health care according to agreed upon federal standards.
The U.S. government has already made a huge mess out of health care- the biggest in the world it appears. I don't trust them. We've already been screwed by industry lobbyists. They need to take a back seat and let the states run with this for now. As per our constitution.
I am 100% in favor of various plans at a state level. Vermont was going to do single payer before Obamacare. That's what I want to see. States will copy successful systems, and an amendment can eventually be passed once enough states agree on a federal system.
Besides the fact that is how it's supposed to work in this country. The constitution doesn't give the fed the power to regulate health care. That is supposed to require an amendment, which requires something more than a 51% majority because it is a big deal.
Just as abortions aren't outlawed federally, I think making sozalized healthcare equally available will perhaps be similarily difficult as it is to make abortion equally available.
And having one federal system creates corruption - a one-stop shop for lobbyists.
Do you really want congress and the president deciding on budgets for various illness, prescription costs, what is covered, etc?
I was pointing out that this is what makes America "varied" compared to other countries and it will introduce complications and variations in how a healthcare system is going to work for it's citizens if they do try to mimick Canada, UK, etc.
I would also hope that the hospitals have a bit more autonomy and they aren't hamstrung by congress deciding they aren't allowed to spend more than 5mn on sedatives or some other really narrow and specific budget.