> Because I'm not really interested in abandoning my fellow citizens who lack the means or the support structures to leave where they currently are to the tender mercies of people who plainly don't give a damn about them.

I'd be inclined to agree with you, expect I feel this is what got us Obamacare instead of a better system - and _even then_, there was a multitude of red states that refused to accept the Medicaid expansion, to the harm of precisely the people you speak of. Pushing societal improvements on states that don't want them feels like buying a sandwich for a homeless person and having them throw it on the ground, and I no longer feel its worth the effort.