@ Worstal - Re: Good question
The problem with breaking any US system into smaller/efficient units is portability - both of coverage and patient.
At one level, the US is a single jurisdiction. However, there is a second level with 50 separate jurisdictions - each with their own ideas/laws/etc. However, there are no restrictions on movement between these sub-jurisdictions. It's a simple matter for me to drive or fly to another state and my health coverage needs to work there as well. If we break down the health system into smaller units, cross-unit coverage between jurisdictions will be just as problematic as it is today between private insurers.
Example: Outpatient Procedure X costs me $200 if I use an "in network" provider. Once my annual deductible is met, my "out of pocket" portion of that is 10%. If, however, I use an "out of network" provider either by choice or because I am across the country on vacation/assignment, that procedure now costs $500. Furthermore, because I am "out of network", my portion of that is now 30% - double whammy.
Any designed segmentation of the US system into smaller and more efficient units must also take the above example into consideration. It could work, but must be done very carefully. Given that politicians and for-profit people will be involved, you can be certain they will get it wrong. Very VERY wrong. The ACA ("Obamacare") is a shining example of exactly HOW wrong they can be. All politics aside, the intent of the ACA was laudable, but the execution ultimately made a flawed system even worse.