That the U.S. has the world’s highest death toll from the pandemic has renewed criticism of the federalist system that has allowed the states to do as they please, with very different approaches and very different results.

“There’s a pretty strong argument that the confusion we’ve created has, in fact, cost human lives,” said Donald Kettl, a professor at the Lyndon B. Johnson School of Public Affairs at the University of Texas and author of “The Divided States of America: Why Federalism Doesn’t Work.” “We pay a pretty high price sometimes for letting states go their own way.”

He added: “The founders were very conscious of the fact that it was a collection of states that had succeeded in winning the Revolutionary War. If you roll that forward, you end up with this patchwork of different vaccine priorities, mask mandates and lockdown rules, because the federal government cannot force states to do things.”