It is well to remember that in The United States of America (the official title),like Scotland, there are many people who identify more with their state or region than as 'Americans'..unless the country as a whole is threatened as it was in WWII.

There are many who, as with Scotland, would prefer to have even more 'independence'. They want their various laws, taxes, religions...etc... to reflect a particular cultural norm, and have little interest in 'what's best for the country as a whole'....thus, the current health care debate.