Fun and thought-provoking, Nolan. In some ways, many if not most of these areas already recognize this reality and function across jurisdictional boundaries. In the wake of bioterrorism, there has been a lot of attention paid to cross-jurisdictional communication, easing unnecessary boundaries and avoiding redundencies. A quick look at the Tennessee/Kentucky/Virginia nexus can show you that. Hospitals, first responders, planners have worked mightily together. On the other hand, those areas which fail to recognize their cross-border realities suffer — such as the inability. of health and other statistics to fully delineate the true picture of the opiate crisis in the multi-jurisdictional region around Huntington WVA. Failing to recognize the realities beyond our current geo-political lines limits us — thanks, Nolan!!