Medicare for All has been introduced in every congressional session since 2003 and has grown more favorable in the public’s eyes each time. Polling from State Policy Network’s State Voices project shows that 72% of people now support or are open to the idea of government-controlled healthcare, with one-third outright believing it would be the best option for America. Majorities of all major demographic groups, including 56% of Republicans and 76% of independents, are convinced something must change in our healthcare system and would consider a government-provided option as part of that change.

But opponents of a single-payer system shouldn’t start panicking yet. Though the public is persuadable, Democrats are not planning to make any big moves, in part because they don’t have the political support. President Joe Biden, for example, campaigned against single-payer healthcare. And his presidential statements on healthcare largely focus on convincing skeptical people that the 14-year-old Obamacare is making a difference rather than proposing bold new action. Even the most progressive wing of the Democratic Party seems to have put a hold on its plans, with Sen. Bernie Sanders (I-VT) recently admitting single-payer isn’t going to happen any time soon.

The absence of federal action has created an opportunity for the states, several of which have made some moves toward government-provided care. This is as it should be: The laboratories of democracy are experimenting with policy and inadvertently showing the rest of the nation that government healthcare is a flawed path forward. Indeed, of the dozen or so states that have proposed single-payer state systems, just Vermont managed to pass legislation in 2011. And even then, the program was halted several years later due to the excessive levels of taxes it would require.

More recently, three states — Washington, Colorado, and Nevada — have enacted laws that create a quasi-public option for healthcare. Instead of allowing the state to control the healthcare system outright, these laws establish public/private partnerships in which the state dictates what the public option plan should look like, and a privately run insurance company administers it. However, the early results are as concerning as state-level single-payer programs.

In Washington state, for example, enrollment is low, premiums are high, and the state has had to pass additional legislation to force providers to participate. In Nevada , the incoming governor has signaled he will not enforce the state’s law, which is scheduled to go into full effect in 2026, because it does not address the real problems in the state. Colorado is now enrolling people in public option plans, but just one of the eight healthcare companies that have agreed to partner with the state met the government’s set criteria.

It is unsurprising these attempts to reform the healthcare system have failed. None of the existing public option programs address cost control past a generic government mandate for private companies to lower costs. In fact, these laws take the existing structure of the insurance system and add to it additional requirements and layers of bureaucracy that only raise costs in the long run.

While the public options put forth by Washington, Colorado, and Nevada miss the mark on the reforms we need to see in our healthcare system, the states are the appropriate venue for meaningful changes. States currently set their own policies for insurance, hospital regulation, and medical licensing. And while the federal government sets guidelines on national programs such as Medicare, Medicaid, and CHIP, the states are responsible for administering them, something the federal government has no experience doing. Moreover, each state has the best understanding of its unique needs, gaps, and opportunities for improvements.

States can implement several reforms that will do more to provide affordable, quality care than any set of federal regulations could. They could end certificate-of-need laws that require government permission, often influenced by existing providers, to open new healthcare facilities, expand telehealth, allow practitioners to work across state lines, and expand the scope of practice to let nurses and nurse practitioners work to their full level of training. Each of these reforms would expand access to care and lower costs.

The public is hungry for effective and tangible ways to improve our nation’s healthcare system. Many mistakenly believe those changes must come from the federal level, which leaves a limited number of possible reforms.

As several states have demonstrated, those reforms, particularly government-provided healthcare, are not going to produce the results people want to see. Instead, we should look to the states to implement policies that will reduce the cost of care and increase quality instead of looking to the federal government to add bureaucracy and complexity to an already overburdened system.

Erin Norman is the Lee family fellow and senior messaging strategist at the State Policy Network.