Public Health Care - Why not at state level first?

[TomCollins]

To those who want the government to nationalize health care in the US, why does this have to be at a national level? It seems like it would make more sense to make this a statewide issue. Many states are larger than a lot of countries that provide the same thing. So size can't be an issue. Having it as a state issue would allow a form of competition between other states, so those that did it most efficiently would likely get rewarded. States also allow easier divisions where larger portions of the population might support it (California would support a government health care scheme before Montana).

So big government zealots- where am I wrong? Why is a state-by-state basis for this a poor idea?