[philipps]

My impression is that the states who argue for small federal government, and for solving problems locally, seem to also prefer private sector solutions over government services (state and federal). So, the choice is not really between federal or state government, but between government and no government. And secondly, things like healthcare are expensive. Making it the sole responsibility of the states means that poor states will get poor healthcare. That is one reason all developed countries have some form of government provided or regulated healthcare system.