I didn't blip over your argument, I rejected your premise. Economies of scale mean it works better the bigger it gets (up to a certain point in most cases which I already said, whether that point in this case is greater than a state or less than a country I'm not going to make any sort of claim on). If I'm manufacturing a widget my fixed costs aggregate over all widgets produced. A prototype is extremely expensive. The first 10 million are much cheaper. The next 90 million are even cheaper than that. Yes the benefits get less drastic on a per unit basis, but the total savings for that last 90 million could still be extremely significant. Whether this actually applies to health care I'm not about to say because its incredibly complex, but the idea that it would work is not an outrageous one.

Now that I'm done defining what scaling means... I think it would be great if the states could actually get it done, but the lower the office the less scrutiny is placed on an elected official and the more influence insurance companies can exert on them.

>The alternative isn't "Federal plan or nothing"

I'm well aware that federal action is not the only possibility, but I and many other people think it is the best one which is why we support it.

>you shouldn't need to force people to take advantage of them at the point of a gun

Who is advocating this? I would support single payer despite being in the class with incredibly low health care costs, but I know thats not going to happen any time soon so I advocate a public option. As the name implies, it is an option, not mandatory (as opposed to the boondoggle that actually got passed which I'm only okay with because it does have redeeming qualities that make up for the corporate handout). I believe state governments simply don't have the resources to set a system like this up.

Other arguments for federal action on this issue:

- it is a fundamental human right that must be protected at the highest levels. States protecting free speech doesn't mean federal doesn't need to.

- a uniform minimal baseline is desirable, on top of which the states can build how they choose.

>Big Medicine is pretty Big already.

Its objective is not to provide health care. Its objective is to generate profit. It is extremely good at generating profit, but not as good at providing quality health care for anyone who needs it.

>It's never a choice between "the Feds do it" or "we sit on our hands"

Who has ever said that it was? It may be the best choice we can get done.