I think our Founders were keenly aware of human nature and their propensity to vote themselves goodies given the opportunity. I think they were also keenly aware of a "general" government's propensity to go prospecting for those people. In spite of themselves they created a document that would bar the general government from doing just that. The states were not under the same restrictions and could have implemented all the nanny state foolishness they figured they could get away with - and could pay for. What went wrong? The "general" government violated their part of the compact anyway and proceeded to take us down the garden path. A centralized government will NEVER rein itself in! They will continue to consolidate power and control until they're stopped.
With Medicare people can go to whatever doctor they want. They do not need permission from a gatekeeper.
Do you approve of Medicare?
I did until I saw ads on tv to givet fat people free scooters paid for by medicare. Als why should a working stiff who can not afford insurance pay for a multi-millionares insurance?