That said, that's roughly what the ACA ("ObamaCare") will likely end up with, if it doesn't get derailed, except that it'll take a few years to get there because 50 states is more complicated than one.

Actually, it could scale reasonably well, but for political reasons wasn't set up that way. So instead, each state will set up its own exchange; I suspect some will be MA-quality, some will be better, some will be poorer.