NB: We have to address it as a nation, because programs like Medicare are national programs. The ACA is a national health reform initiative. Hospitals, nursing homes, hospices, are in some ways regulated at the federal level and in others at the state level on their funding streams. It’s always going to involve national will and priority setting in addition to what’s being done at the state level. But all care is local. Some journalistshave done a phenomenal job demonstrating just how difficult it is to piece together the care you want, the care you need, unless you’re very wealthy. So these raise other problems of justice and fairness in addition to quality issues.