"three questions come to mind.1 - Why do you think the Federal Government's plan would be more efficient? The Federal Government isn't exactly the model of efficiency."Having 50 different plans, 50 different sets of rules, overhead, management, analysts, etc. does not strike you as being most likely inefficient? "2 - What if a State has a "better" plan? Should they be allowed to get a waiver? Why is the Federal Government holding back the States?"Not sure about that one. Who determines it is 'better' and how? I would think that a waiver system would work, as long as the states plan met the criteria. "3 - Why do you think one size fits all is a good thing? The best plan for a State like Delaware might not work in Idaho."I'm not sure how health care is that much different from state to state. How would a plan 'not work' in some places and 'work' in others?"Just because 50 plans would be inefficent, doesn't mean one Federal one wouldn't be a disaster either."No question, I agree. The worst case, of course, is that you could have 50 disasters, using your same logic.