What people simply don't realize is that Social Security and even Medicare is not completely universal. Regarding Social Security the Big Railroad Retirement Pensions did not participate and neither did many others like the Post Office, some State (public and state teacher trusts) employees like Colorado's PERA or Wisconsin's WEA.

If some states for whatever reason politically or what not do not want to participate in what is unquestionably a better financial formula to manage healthcare (or as Obermann puts it "stave off death") than by all means let them try. Like a number of states that underfund and underappreciate public and collegiate education, there will be state societies that will gravitate to the bottom of the social-economic ladder while other states more progressive will gravitate near the top.

Putting together a research report as to why Colorado's major metro areas experienced greater job loss than other cities even though Colorado didn't have major auto or manufacturing business it became clear that the state still didn't have the depth or breath of a wide variety of industry sectors like Boston & Dallas (comparable Denver), Madison & Austin (two cities comparable to Colorado Springs) that not only included new tech firms, but also a deeper commitments to education, engineering, healthcare and finance.

If it takes the form of "choice" to trojan horse what is fundementally necessary for this nation to move forward where 2/3's of the states "Opt-In" with possibly 80% of the populace than so be it. Eventually state legislatures become very practical and rational when faced with the prospects of not being able to pay for things.