Risk pools in other countries work pretty well, and their populations are <= that of pretty much every state in the Union.

Denmark’s population is that of Wisconsin.

The least populated state (Wyoming) would have a larger risk pool than Iceland, which seems to be doing fine.

Sure. For that matter, some bigger corporations in the US choose to run their own.

But it is just math - bigger pools have more resources over a larger population, and so are better positioned to survive shocks.

You’re not really refuting my point...by that logic the entire world should have one big shared risk pool, it’s just math!

My point is that you can have adequate risk pools at a lower administrative level (the states), while not having to deal with having to build up political will among a large, heterogenous polity.

That's because I'm not arguing with you.

It is a complex topic, and the variety of "solutions" to the problem give us a lot to chew on.

I don't personally think that's optimal - there are a number of problems US states have that nation-states don't. (Deficit financing, exclusion and latitude to make its own rules being larger ones.) Also, one cost of running "laboratories of democracy" is that some of them fail, and some of them are run incompetently or corruptly or cruelly.

But if you like the idea of state level fixes, by all means pull for that. There is no single right answer.

> Also, one cost of running "laboratories of democracy" is that some of them fail, and some of them are run incompetently or corruptly or cruelly.

That is true of nation states as well, and yet we trust them with sovereignty.

In our Union, states have to abide by a baseline set of rules per the Federal Constitution (free speech, right to a fair trial, equal protection before the law, etc). US States aren’t run by Kings and Queens, they’re democracies with checks and balances, state Constitutions, judiciaries, legislatures, and executive agencies.

Insofar as a state would be run corruptly or cruelly, it would be the will of the people of those states.

More important is that states can’t control immigration and cross-border trade, making a variety of policies infeasible or much more expensive, compared with the same implemented nationwide.

Immigration and cross-border trade is free in the EU, and yet healthcare is a member-state level issue. In India, healthcare is explicitly a state issue, not a Union issue.

At a glance, it looks like both have mandates of some sort that keep states/countries from going full-on free rider, which is what I expected.

Right, the US-equivalent would be for States to tie their welfare programs to state residency, which is totally reasonable and within the realm of possibility.