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Why States Cannot Implement a Single-Payer Health Care System

A single-payer health care system has become all the rage among far-left Democrats. Expect virtually every 2020 Democratic presidential hopeful to support Bernie Sanders-type “Medicare for all” legislation. And while the drive is focused mostly at the federal level, far-left states are making their own push. 
For example, California Healthline reports that donations are pouring into the California governor’s race. “Both Newsom, California’s Democratic lieutenant governor, and Chiang, the state treasurer, support the concept of single-payer, which would offer universal coverage to Californians, likely at a significant cost to the state.”  
The problem is that implementing a single-payer system at the state level is, practically speaking, impossible—thanks to our federalist system. 
The goal is to cover everyone, no exceptions. For example, Vermont Governor Peter Shumlin boasted that his state’s now-defunct single-payer legislation would cover all 620,000 Vermonters. 
The problem for state-based single-payer efforts is the federal government is already heavily involved in providing

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