> We discovered that focusing on highways and cars was ultimately not very good. But it achieved the goal it set out to do, so I don't get what your point is.

That's exactly the thing we're arguing against — a monopoly/monolith doesn't necessarily know whether the goal is the correct one. Enterprises rely on competition to arrive at the "correct" goal. The argument is to allow State actors to do the same. Discovering that something is "not very good" after experimenting on 300+ million people is worse than running those experiments and observing those failures more locally at the State level, where failures impact fewer people. GP commenter made the same argument, as follows:

"Additionally, we shouldn't be trying to put all of our eggs in one basket. Should we have single-payer healthcare nationally? No one knows if that's the most appropriate solution for all of the US, but why not let cities or communities try various localized healthcare strategies out for themselves. Each may try things differently. Some may work and some may fail. Other places can see how things worked elsewhere and either decide to improve, not implement, or take verbatim what another local government has done. You influence change by setting an example and letting others decide for themselves, not by trying to force the world to behave as a small subset of people want."

I don't know that I agree that healthcare systems should be fragmented at the city level, but there's really no reason why States shouldn't drive healthcare policy and try different approaches. Switzerland, Denmark, the UK, Singapore, and Germany all have wildly different healthcare systems — all with their own merits and demerits. There isn't a single system that is objectively "the best". States can enact the policies that the citizens want the most, and we can see for ourselves how they do.

> This is an absurd argument. What are you even trying to convey? That the Federal Government should take charge of providing healthcare? OK then.

And this is an absurd reading of that argument. The argument is that we got to where we have because the Federal government started off by 1) imposing wage ceilings that resulted in employers offering health insurance to get around those, 2) enacted a tax deduction to incentivize employers to keep doing this after the wage ceilings were lifted, and 3) instituted a mandate for employers to provide health insurance. These are all terrible policies, all advanced at the Federal level. It should then follow that we should reduce the degree to which the Federal government makes these decisions, not increase them. You don't promote a bad decision maker, you fire them.

> Medicare/Medicaid/ACA are all Federal policies and provide healthcare to millions who wouldn't get that otherwise.

Medicare subsidizes healthcare for overwhelmingly rich people (old people are the richest cohort in America, owing to a lifetime of accrued income). Does that mean we shouldn't subsidize healthcare for any old people? No, not at all — Medicare was just local optima. ACA entrenched employer-sponsored health insurance via the employer mandate. Are individual mandates bad policy? No, not at all, that's how Swiss healthcare works. But ACA was more than just that, and got us stuck in local optima.

Again, that's the entire point — when we give a monopoly sole decision-making power, it's very difficult to get ourselves out of local optima, especially when the polity is as ideologically polarized / heterogenous as ours.

> Again not sure what your point is. EU has Federal agencies too, yeah, so what?

Exactly. The argument is not that the US should have 0 Federal agencies, it's just that it should look more like the EU, writ large. One of the foundational principles of the EU is "subsidiarity" -> https://en.wikipedia.org/wiki/Subsidiarity_(European_Union). I (and ostensibly, also GP) argue that the US ought to follow this model.

> Hard disagree. While States have been great for introducing and experimenting with new ideas, spreading those ideas across the country requires Federal Investment and oversight. Obamacare traces its origins to Romneycare in Mass, but it required Federal dollars to bring it to the rest of the country.

Yeah but that's just because most of that taxation goes to the Federal government. There's no reason that can't change, and for the majority of one's taxes to go to their State government. Today, I pay around ~30% of my income to the Federal government and ~10% to my State. The argument is to make that the other way around, so that you don't need Federal dollars to bring things at the State level. This is exactly how it works in Switzerland, where the top marginal rate at the Federal level is ~10%, and Cantonal rates vary between 16-30%. Switzerland isn't some "libertarian" hell hole, it's one of the most prosperous nations on the planet. Likewise, the EU's leaves taxation entirely to its Member States, and not only do they do just fine, some of their States are arguably more prosperous than the US.