There is no such thing. Many states are larger than many countries that currently have a single-payer option. There are serious political advantages to forcing the health insurance industry to fight state by state.
As one of the major elements destroying our national productivity, it is important that a public option or single payer go into effect next year. If some states choose to opt out, we can take the fight to those states.
On the remote chance that any congresspeople might read this, here's a 'compromise'. Demand single payer, or a public option that is difficult to distinguish from it. Demand it begin in 2010. As in January 2010. Let state legislative bodies opt out.
What you don't win in 2010 you will win in 2011.
As I see it, there are currently three major factors dragging our economy down. The most important, by far, is the lack of a robust health care system. The other two are probably for a future discussion, but their importance pales compared to the damage the American health insurance industry has done.
The health insurance industry interferes with labor - they take up physician time, they take up administrative time, they take up patient time - even when they actually do provide care. In terms of economic damage dealt, the health insurance industry rivals the trade deficit. This is even before considering those not cared for, or given inadequate care. Millions of Americans are less productive than they can be - if they are productive at all. Medical bills leave many to be financially frozen. Stress and worry take their tolls as well.
A quality single payer or public option will restore the national economy after a brief impact. It does not need to be implemented for every state immediately to do so. But what does get implemented needs to be good, and it needs to come fast.
This will let people worry less, and focus on building things. Building things is what makes economies. Whether or not someone sticks a price tag on it is irrelevant in comparison to making sure people can be productive.
Even if it only meant immediate reform in half of the nation - a possible worst case scenario - the results would be felt over the summer. Those states can then focus on improving the quality of health care. Require higher standards, allow a limited number of hospitals which expressly focus on higher quality care to charge patients a percentage over base for that or require a plan, etc. and so on. There's room even in single payer for capitalist ideals like that.
But we need this and we needed it in 1994. It needs to work and well. If it is implemented well in the states that don't opt-out, the remainder will fall into line. As an individual, you, your friends and family have far more influence on your state representatives than you do on your delegate to Washington.
I voted for change. I want it now. If it means my state has to wait because a republican governor wants to commit political suicide just before he runs for presidency, it may be my own death warrant too.
The economic boon of tearing an overfed leech off of the economy - the health insurance industry - is too great for any state to ignore it for long. It is still change.