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Brad F

I would add that while NYS, my home, has a "unique" Medicaid program, as compared to Georgia, the problems upstate residents face here are more similar to rural Georgia than that of NYC folk. Similarly, the same can be said of Atlanta residents and say, Valdosta.

With a majority of US citizens in urban locales, the trade offs are not so clear. The laboratory of democracy calls, and the "let the 50 flowers bloom" slogans certainly have merits. However, scale and efficiency seemed to get lost in the mix when couched in in the warm and fuzzy tones of federalism. I dont want to gloss over the advantages of that approach, but it sometimes seem those (not all) that propose it, dont weigh the trade offs and possibility that on the net net, an "all in" approach may have more heft.

However, no one model is a home run. We do have to make a choice though.

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