Third, they will never be able to enact a Medicaid scheme that would pay the same rates in rural Iowa as in downtown Miami or Midtown Manhattan. If you think the healthcare unions in the cities have been holding angry rallies now, you will really see some if that is allowed to take effect.
Finally, the overarching consideration is that there has been no serious debate about what the federal government is doing getting so enmeshed in the provision of health care to begin with. Nowhere in the Constitution is Congress or the executive branch granted the power to provide for or regulate the provision of healthcare. The 10th Amendment grants that power to the states. Healthcare provision should never be a political issue, it's a personal one.
If the government was not so closely involved, prices would be lower and more people could afford the basic care that they need most often. Private charities, mutual benefit societies, and the generosity of providers could help those unable to pay for routine care. Creative insurance products, unburdened by mandates, could help with the low-frequency, high-cost cases and be priced competitively. Obama just doesn't get it.