It is strange that it only took a single generation under a new system of healthcare to spawn the new nation of "Medarchy of America" or M.O.A. It lies nestled in the heartland of the original lower 48 like a beacon of reason in a convoluted world.
The East Coast was another story entirely with constant struggles to contain urban unrest and dwindling white populations all heading west to the heartland and M.O.A.
The old U.S.A. structure was still hanging on in Washington D.C. like some zombie entity refusing to die. Representatives and Senators no longer even attempted to go there any longer preferring to stay close to their local bases and take care of their constituencies. It was the abolishment of the Internal Revenue Service that put an end to the United States as a single nation of 50 states. The lack of spending power ended the increasingly one-sided political balance of power. At least the United Nations had the grace to relocate to Switzerland. Their new-found reliance on funds from Islamic sources to continue the farce of being a "New World Order" allowed them to continue the charade. With her "broom" of cost-consciousness, the new mayor of New York decided she didn't want to be the host to the free-loaders any longer.
Even with a military establishment split into three distinct sectors, each of the new nations remained secure enough to deter any encroachment. The W.C. Pacific Navy was the strongest fleet on the oceans projecting sea power around the Asian continent and giving the separate territories of Hawaii and Alaska safe harbor. The E.C. Atlantic fleet was smaller but had the advantage of nuclear submarines that still dominated most of the modernized world. The E.C. territory was industrially self-sufficient and with the exception of labor disputes and social unrest in the major urban areas, it was a strong and well-balanced power.
Of course, the West Coast or W.C. had opened its doors to the hordes of new immigrants. In fact, there no longer existed any border to the South since the below the border populace was more interested in commerce and freedom to live as individuals than in criminal pursuits. Non-assimilated Spanish-speaking families fled from the M.O.A in the heartland to the W.C. for a more desirable lifestyle that welcomed them as equal partners. "Outsider" Hispanic elements in the E.C. also made the trek through the heartland to take up residence in the W.C. nation. Despite the heavy influence of Cuban and Puerto Rican communities, the State of Florida joined with the new nation of M.O.A. and became part of the homeland. It was probably due to the demographics of an aging population that relied heavily on medical excellence.
The only area in the M.O.A. that was not considered sovereign territory was the enclave of Chicago and the remainder of Cook County. It tried to break away and join with the neighbors to the north but the political forces north of the border saw it as a serious drain on their economic and medical resources already strained by rising health care costs. The solution there was that the M.O.A. looked the other way when medical cases entered the new nation seeking medical assistance providing the patients made an honest effort to pay their fair share based on income. At last report, droves of Chicago residents had relocated to the M.O.A. to escape the high taxes and the lack of adequate services.
The organizational structure of the Medarchy of America is similar in most respects to the original American Constitution and the Bill of Rights. There are several changes that were voted on in regional referendums that found overwhelming support. The non-recognition of Washington D.C. as the head of government was not the least of the changes. Probably, the most radical of all was that each of the component States would now be ruled politically by cadres of Physicians and certified health care workers who reported to the central M.O.A headquartered in Atlanta, Georgia. Major hospitals in each city of the M.O.A. became the seats of local government. Federal buildings were abandoned and shuttered up because the Washington D.C. government had no funds to maintain them. The individual States continued to function as before only now they pooled their resources for their National interests to insure a singular purpose.
The hospitals and the clinics and the Doctors and the healthcare workers did not consider themselves "Politicians" but ombudsmen for the people of the nation. There was no need for elections since there was no "opposing" party.
The new nation had universal military service for both males and females similar to the Israeli system and the result was an end to profiteering by unscrupulous private businessmen.