peace health geared up to a new system...within existing parameters - it took them almost  a year.... my pharmacy re-geared their process because they were bought out...it took months, within the set parameters, to get it smooth.  multiply that by thousands.  SSA itself would have to re-gear ...every doctor... clinic.. all things medical would have to be redone. and 50 states doing this all at once and being able  to choose their own way to cover?  .. this would be a true nightmare.