Just a couple legal points. (I’m a lawyer, you’re the health care guru so I feel safer here.) Tort reform cannot be entirely solved through federal action but it is a good start and has a significant impact on the legal system as a whole, as was seen with class action reform. As for state mandates, you certainly could pre-empt them through federal regulation. That is what much of ERISA has already done(some of these regs are likely subject to challenge already on this basis). This is what in other areas of the law, such as environmental protection, prevents a hodgepodge of contradictory and crippling regulations. For example, California emission control regs are under attack on just such grounds. As to your point about limiting interstate insurance purchases by allowing them only if in-state costs are not “affordable,” I haven’t seen anything yet on precisely what that means or who defines “affordable” so I just don’t know if your fears are well founded.