Document Type


Publication Date



Health care reform dominates the domestic agenda of the Clinton Administration. Policy analysts, media pundits, and ordinary citizens are abuzz with the once-arcane terminology of health reform – "managed competition," "single-payer," "regional alliances," "global budgets" – as they ponder the merits and demerits of the leading reform alternatives. At the center of the public debate are questions concerning the role of government in constraining health care costs, maintaining quality, and widening access. But in our federal system there are two governments that can address most domestic problems – the national government and the states – and, although considerable ink has been spilled over the issues of how large and what type of a regulatory role government ought to play in health care, relatively little attention has been devoted to the question of which government ought to do the regulating, or how the two layers of government ought to interact in the pursuit of reform. The general lack of concern over the federalism implications of a national initiative that would affect one-seventh of the domestic economy and define national policies for areas traditionally left to states the is striking. Yet, given the propensity of policy analysts to debate the substance of proposals while ignoring issues of government structure, the inattention to federalism is, sadly, not surprising.


Health Law and Policy | Law