Re-Figuring Federalism: Nation and State in Health Reform's Next Round

Publication Date:

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Author(s): L.D. Brown

Research Area: Health

Type: White Paper

Abstract:

This article examines the role of federalism in potential reform of the United States health care system. It first examines the current role of state-federal interactions, particularly through Medicaid. It then looks at the health care systems of three countries with federal systems that have achieved affordable universal coverage: Canada, Germany, and Switzerland.



Key Findings:



* The central challenge of health reform is to reconcile sub-national variation and discretion with a national set of rules that steers between rigidity and indulgence in ways that are substantively workable and politically acceptable.
* Well-working, though costly, systems of universal coverage are compatible with federal systems of government.
* Implementation of such a system in the United States would require several major departures from its current system, including a central set of guiding rules, the elevation of health coverage to an entitlement of citizens, requirements that physicians accept fees set by national or sub-national players, and constraints on business practices currently central to the United States health care system.