make it so the fed govt pays states that reduce health care costs. also create commisson to oversee qual of care in each state to over ride paying them rewards for cutting costs if qual is bad.
this way, states can make choices and do things like recruit young people.
they get more money as rewards for being first to cut.
the most important thing in health care is rising care costs. those are set by local forces such as liability, insurance, etc. state govt's would have best way to drive down costs if they were rewarded for it.