The Utah model, were it to be expanded beyond state lines, would end up very much like this.

The problem is Washington, meaning the interstate commerce clause would be used to regulate things so that "big government" gets its "cut".

As in my comment above, Entitlement is key, because it's the only means they have to "sell" your stash to "buy" their next votes and gain the control needed to be able to repeat this process, ad nauseam, and if necessary right into bankruptcy, yours, ours!

The alternative is to leave these things intra-state entirely. Should this work for a relatively small state like Utah, then it could presumably work anywhere. Other states would likely emulate it. And, the costly "Fed", who can't even run the Post office efficiently, could be out of it for keeps. To me, that's a real hope, not the nightmarish Obamacare.

BTW, I think they're aware of this and that it's their last chance for some "real" control plus a guaranteed future income, as well as not having to deal very soon with the Medicare/Medicaid accumulated debt nightmare, which is why all stops are being pulled. Let's hope they lose!

It seems to me that the problems of accessibility, portability, community rating, pre-existing conditions and affordability can all be solved by forming several giant risk pools. What are the barriers to this being accomplished either through cooperative pooling among contiguous states, or a national rate and product competition to see which health insurers will be the oligopolists authorized to run these necessary pools?

The states would have to drop their coverage requirements in order to allow the bidding health insurers to offer a range of coverage options at different price points. Their role would be reduced to policing fraud. Many insurers would have to leave the health field, causing unemployment (but the gigantic winners would be hiring). The Feds could theoretically eliminate all of Medicare and Medicaid, allowing premiums in the large pools to drop. Tort reform would get rid of defensive medicine, and drugs, eye, mental and dental care could be included.

Where am I wrong on this? I'd really like to know as I'm a senior who will be profoundly effected by new legislation?

Likely emulation at the Federal level? — Don't bet on it! — Why not? — No entitlements!

Washington has for a very long time now been into the "entitlements game", meaning: if you can't "pork it", it's no good! As proof I need only offer the size of their "bills" — pun intended — a billion per page seems to be the current rate!

Entitlements are to Washingtonian politics what sex is to advertising: It gets the viewers' attention, then lures him with false hopes to buy a product he doesn't need, to impress people he couldn't (or shouldn't) care less about, while filling the till of those who care even less about him.

Doesn't that sound like the recipe for "bringing in the vote"? Well, it does to me! Entitlements do differ, however, in one big way: while the money spent would seem as virtual as the sexy image, and the ensuing control is just as real, in politics the money is other peoples' and the product can never be returned, and even the "used" market has few takers. I'll wager that Washingtonians "bank on that" — again, pun intended!

Voters seem to be learning (and will need to remember) that it was their money before someone else took it to spend in "their best interest"! — Say again, "whose BI"? My point, exactly!

Let's keep our fingers crossed for Utah and (hopefully) many emulators!