Yes, Matt, for instance if Massachusetts, Connecticut, and Rhode Island combined forces their GNI and population figures would approximate that of Switzerland.
“…and at the same time making our system needlessly complex.”
Needless complexity is a traditional tried an true method of providing good profits to multiple insurance company participants in a market. If consumers can readily compare costs and benefits then the ability of insurance companies to pad profits and complete based upon hype and the ability to train and retain slick sales agents is increased. If insurance plans are kept simple and similar across all companies and the market is properly regulated, then buying decisions would simply be based upon price and service reputation and insurance company profit margins would be much lower.