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State by state is a horrible idea for any welfare policy. The problem is free riding.

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How is free riding a problem? That's the entire point of socialized medicine.

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Mr. Jones needs a kidney transplant, but lives in a low tax state with crappy health care. So he moves to another state with high taxes and great care to get the kidney transplant, then moves back to the low tax state when he's healthy.

Obviously there are ways that states can combat such free riding problems, such as requiring residency for a certain period of time, but free riding is definitely an issue that would need to be dealt with.

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Who said anything about "great" care? Begging the question 101.

Anyway, what about the people who live in that state the whole time? They aren't free-riding? That's who I was talking about. To keep out the riff-raff, I suppose you'll need to erect some walls, and probably issue papers to all citizens so they can be identified as needed.

Interestingly, I don't know anyone who's moved to canada to get (e.g.) a free kidney transplant. I do, however, personally know *lots* of people who have come from countries with "free" (or "great" if you prefer that term) health care to the US to get private health care (e.g. luekemia treatment).