I'm not in full agreement here.

1. Health care is expensive, but it's also gotten much more sophisticated than anything else, with the highest research costs, and using the most expensive (since it's singular in distribution) delivery system there is. As long as people don't get "efficiently sick or injured," the medical services cannot dispense health care very efficiently. Sure, some care can be, but most is reactionary to an individual event.

2. Not having health insurance doesn't mean people don't get health care services. Government (federal, state and county) subsidy of health care costs for those without resources and those in special situations (Indian reservations, veterans, over-65, and a host of others) is immense, but whether the subsidy is efficiently being managed is another story altogether. Insurance is nothing more than a pooling of resources by a select population and subsequent sharing in the pool should the insured have the need. Insurance isn't a right, as who can enter the "pool" is subject to whatever restriction the insured want to place on membership.

So, it isn't criminal that 50 million people don't have health care insurance. What would be criminal would be if people didn't get emergency health care help - and that's not the case.

While 50 million is just under 17% of the population, the real question is where are the 50 million people located? Are they evenly distributed among all 50 states, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and the Minor Outlying Islands (Midway, Wake, Jarvis, etc)? Are the 50 million mainly in the top 15 major cities? Are the majority massed in select jurisdictions? Do we even know?

The reason why knowing where the uninsured are is whether this is indeed a federal matter or a state one? As of late, the tendency is to make every problem of every kind a federal matter, despite the fact that Washington has a lousy record trying to manage at the local level. What works in Cleveland (OH) doesn't necessarily work in The Villages (FL), or in Round Rock (TX), or in Casper (WY) or in Tacoma (WA) and so on. If the federal government could indeed manage health care locally, the Department of Health and Human Services would have already taken over State and County health departments, set a national health care professional license registry, and literally put the states and county agencies to pasture.

When it comes to realizing the differences and uniqueness in populations and requirements among the states and territories, the best the federal government can do is determine the lowest common denominator and manage to that level to include delivery of services at that level. That's what would be considered "fair" from a spending distribution policy and anything else would be a battle-and-a-half.

We had state governments before we had a federal government. They fit the bill here, not the fed.

So, what do we here in Florida want to do about health care within the State of Florida, based on our geography, population, and local needs? The other states need to do the same, and all states recognize that Washington was never meant to be all-powerful, all-directive and all-controlling over local matters - unless we want to be satisfied with a lowest common denominator system.

ONE LAST COMMENT: The Canadian model is not a good one. We're talking about a nation whose total population is equal to California's. It's not a one-for-one comparison, as Canada, despite its physical size, doesn't have the delivery requirements the US does. Canada's system may work for selective states, but not as a US federal system.