I don't think so, kuroiwaj.  At least, I don't think it HAS to be that way.

And, CONGRESS HAS SO FAR REJECTED THE STATES CONTROL OPTION. 

But, I think all Americans should have affordable and accessible healthcare.

So, I think the reactive prominence of single payer healthcare has become a necessary part of the discussion.  Perhaps just to show conservatives how far off the tracks things could get for their dogma unless they wise up.

I personally don't have a particularly large problem with an efficient, well functioning single payer system.  Definitely not philosophically, like most conservatives do (for reasons I either do not understand or abhor).

If your instinct was to frame the "either, or" in order to advance (scare up) opposition to ANY federal involvement in healthcare, then, frankly, I have no respect for that.  But, I assume your point was based on genuine analysis, rather than dogma, therefore, the response preceding.