[AlexM]

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Sounds nice but how does this jive with a national health care system?

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In theory the federal government would mandate that health care be accessible to all citizens (forget for a moment the legality of the federal government making such a decree). The states would be responsible for delivery of health care. Each state would have room to design their state plan to suit the needs or residents of that state, within limits defined by the federal government.

This is essentially how the Canadian system works. For what it's worth, the way this arrangement has escalated the conflict between the provincial and federal governments here in Canada is a not a good indication that this type of arrangement makes sense.

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If the federal government's mandating it, that's centralized.