Health policy and state initiatives

Abstract

Abstract As the polity grows impatient with the status quo in health care but fears “too much government,” the states are repeatedly invited to lead and innovate. Several distinctive features of American political life lend recourse to the states a hardy, if not perennial, appeal. The United States is a federal system whose constitution honors states’ rights in several social spheres. Political culture-traditional American distaste for big, central government and the corresponding affection for checks and balances-powerfully reinforces these formalities. American lore contends that states are “closer to the people” and hence more responsive than national government to the demands of the people. States are also said to be “laboratories of democracy,” valuable testing grounds for policy innovations that may wax or wane incrementally in the clarifying light of subnational experience (Leichter, 1996). And devolution-turning back power to the states-is a staple of the conservative agenda that understandably enjoys much political “prime time” when, as in the last 30 years, conservatives have been powerful.