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I mean, there is quite a bit of precedent of universal/single payer healthcare starting off in just one part of a country. Take the Canadian healthcare system for instance, which started in just one relatively tiny province of Sasketcheawan.

The issue with doing it in a single state is that there isn't a single state which doesn't have its politicians completely bribed and at the beck and call of Corporate America, who will fight tooth and nail for its blood money profits rather than having a cheaper more efficient system set up.