Several Republican leaders have suggested that the best way to reform healthcare would be to allow people to buy health insurance across state lines.
I believe that this would be a very bad direction to take reform.
The reason for my position is that insurance is a contract for care. To ensure that a customer receives care, they have to be able to sue the insurance company in their local district.
Anyone looking at the dirty workings of insurance discovers that the industry is an ugly nexus of lawsuits with insurance companies and care providers in ongoing battles of claims and counter claims.
The very terminology of the game gives this away. When the insured visits a doctor, they do not pay a bill. The insured issues a claim against their insurer. There is a later settlement between the doctor's lawyers and the insurance company's lawyers.
Allowing people to purchase insurance from across stateliness introduces jurisdiction problems into the dance of issuing and settling claims.
Of course, the state boundary issue is far less of an issue for the Medical Savings and Loan. The policy holders negotiate and pay their bills in cash eliminating the need for the complex claim structure of insurance.
Since insurance involves a complex claims process between multiple parties, I think it is unadvisable to allow people to buy insurance from different states.
I believe the difficulties of portability simply show that pooled insurance was a bad idea from the beginning. Rather than coming up with increasingly complex regulations and tax breaks designed to make a bad idea work, I think we would be better of scrapping insurance as the primary means of funding health care and return to a more civil day of direct negotiations between doctor and patient.