>But the annoying thing about American federalism is that we like to do things 50 different ways
This was how the system was originally designed to work, as specified in the 10th amendment. This is also how the European Union works - a federation of independent states.
That's much better then everyone getting stuck with a federal one-size-fits-all solution that is sub-optimal (or corrupted), which does happen sometimes.
Different states can try different things, and copy what works amongst each other. Once enough states agree on an optimal solution an amendment can be passed forcing any lagging states to the new solution. This could apply to things like civil rights, health care, etc.
For example, before Obama-Care we already had states trying things - Romney-care in Massachusetts guaranteed coverage to all, Vermont was ready to implement a public plan that they had to cancel, NY and California also had significant reforms in the works, etc. Most assuredly the best solutions would have risen to the top and have been copied. But now that can't happen, because for better or worse we are stuck with a contentious law that was passed and is not easy to change. Perhaps the big insurance companies were afraid there profit margins would be reduced, so they negotiated a good deal for themselves with congress? (they get subsidized premiums from the government, and the public gets to pay the deductibles, without the ability to shop, company plans reducing individual choice, etc)
I don't believe it was the intention of our system to allow drastic changes by transitory slim majorities at the federal level. It seems that everyone with an axe to grind would like a federal law (or better yet a Supreme Court case) to force their opinion on the entire country, and that is not right. Our government is an outgrowth of our culture. Tweaks to the system are not going to change what people believe in.