The fed gov plays a role. If we just let states do whatever they want, then that's exactly what they'll do. That's why we need federal programs and depts - like the EPA and a federal health care law, for example.
And are you seriously suggesting that people in the US
don't die from starvation or lack of health care?

You can pretend that everything is all rosy, but that simply isn't the case.
Not according the U.S Constitution.....but why would our supposed Constitutional Scholar President bother with what it actually says ?

We don't need a federal EPA and we don't need what is termed "Obamacare".
And if you can produce something of substance on people starving to death or dying because of lack of health care (the study was done 10 years ago...that means about 500,000 have passed since then.....not that I have heard about them in mass....but lets forget the 1,800,000 people who will have died from smoking related disease......BTW: 45,000 is how many out of 300,000,000 ? Answer 0.015%....how can you even show statistical significance at those low numbers against an entire population that has so many diverse characteristics and environments (I dunno....maybe no healthcare means no Kevlar vests in Chicago).
Looking for that data.