So yes, it is an impediment but that is the way it was supposed to work in this country - fifty strong, independent states and a small federal government that took care of exclusively federal matters. The problem you mention is compounded by liberal states that mandate coverage minimums, such as preganancy or substance abuse rehab. All of that could be fixed, however, without forming a massive, Draconian federal healthcare system that drives us further toward financial collapse. YOU, as a consumer, should be able to tailor your health insurance to what you need and purchase it from your provider of choice, but that's not possible as long as some states demand that you be covered for everything under the Sun. Why should a devout Mormon or Muslim be required to pay for coverage for rehab? Why should a young, single woman on birth control and with no plans to bear children be required to pay for pre-natal and obstetrical coverage? The governors, state legislatures, and state insurance commissions could do more to reduce health insurance costs than anything Obama or that broom-flying Pelosi could ever dream of. Then again, their goal isn't lowering the cost of healthcare, it's the government taking over one-fifth of our economy and making you more and more dependent upon government for your survival.