The role of state and local government in health. A federal perspective: an interview with Sen. David Durenberger.

Abstract

Prologue: The concept of federalism as it applies to health care has long been a philosophic muddle because Washington and the states never have settled definitively which level of government should assume what responsibilities. As a consequence, tax-financed health programs have evolved in a chaotic and piecemeal fashion. President Reagan and his three predecessors all have articulated views on federalism that favored bolstering the responsibilities of state government The preferred policy instrument has been to lump funds through revenue sharing or grant consolidation and pass them back to states on a reasonably unfettered, but reduced basis. Congress has accepted these proposals, though without much enthusiasm; the legislative branch views state government on the whole with greater suspicion and devotes little time to intergovernmental matters. David Durenherger is one of those rare politicians who not only attends to such issues, but has an abiding personal interest in them. This interest derives from...