Why I think it is challenging for the government to ration our care.

[Occhidiangela]

Simply put, people vote, counties don't. People matter, but the jurisdiction of counties does not, at least in not in state and national politics.

You're missing the deeper point, which is that real Americans don't live in New York. Except for Donald Trump. And during 9/11. But other than that, "real" America isn't the 50% that live in cities, it's the salt of the earth from the rural areas. That vote Republican.

-Jester

You are missing the larger point, Jester.
The people in "fly over country" seem to have gotten tired of the multitude of urban assholes screwing up the country: they want their turn to screw up the country. This time, some of the got off of their asses and voted.

Seems fair. In four years, I predict that the pendulum will swing again.
Notes:
1. We still didn't crack two thirds of eligible voters actually showing up ... too bad.
2. In a similar case, in 2008 more of the black voters got off of their asses and voted -- which was IMO a good thing all by itself -- but that seems to have been a spike rather than the sign of a trend. A shame, but at least there's hope.
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In response to kandrathe's OP, a government that can give you what you want is powerful enough to take it all away from you. The balance point you seek is ... well, that's hard. It's also a moving target.