That can make it difficult to implement consistent standards that are not subject to the whims of local politicians. There are also economies of scale that are

That can make it difficult to implement consistent standards that are not subject to the whims of local politicians. There are also economies of scale that are difficult to achieve on a local level. Drug purchasing, for example. A federal government is going to have far more negotiating power. But I take your point. Perhaps the right answer is that laws and oversight are the domain of the federal government, and implementation is local.