[Spooky23]

The Feds pretty much mastered the "how do I make 50 states do stuff" problem -- they give the states money and threaten to take it away.

We've had Medicare and Medicaid for almost 50 years now, and it works reasonably well, despite significant differences in administrative practices between states. So it absolutely can be done.

We've figured out how to build a national road system, healthcare for old people, healthcare for destitute people, a national tax collection system, and 1,000 other examples. It's a solvable problem.

[jval]

Not saying it's impossible, just saying it's difficult and comparisons with other countries are not helpful in addressing those difficulties.