Originally created to serve the poorest and sickest among us the Medicaid program has grown dramatically but still doesn't include the kind of flexibility that states need to provide better health care for the poor and disadvantaged.

Today the demands are for even higher standards in the quality of care for greater flexibility and convenience in treatment times and for more prevention through screening and health checks.

If you think aficionados of a living Constitution want to bring you flexibility think again. You think the death penalty is a good idea? Persuade your fellow citizens to adopt it. You want a right to abortion? Persuade your fellow citizens and enact it. That's flexibility.

Washington is still very much a male-oriented culture. Being from Los Angeles I think it is less so there - there is less attachment to tradition perhaps there is more flexibility more acceptance of change generally. That is partly because of Hollywood.