I think increased Federalism is really our only hope. Increased centralization, or even our current level of centralization, simply makes the central control construct too rich a target to pass up, and too easy a target to capture. This is the 21st century, and everything else is decentralizing; why isn't governance?
We shouldn't be arguing about which one-size-fits-all health care plan should be enacted at the national level (and it's extremely hazardous for an entity which can print money to be doing anything of that nature anyhow); we should be letting the lower jurisdictions work it out. (If you don't think states are large enough to do that, go look at actual stats; many states are larger than entire major European countries and nothing would prevent states from banding together or adopting each other's systems once proved, it's not like poor Rhode Island would have to come up with their own de novo plan. In fact such sharing mechanisms already exist to some extent.)
It is also a trivial exercise to show this permits a much larger set of people to get the much more of the things they desire out of their government, whatever those things may be (including "less things" if that's what the people want).