The route to a national health policy lies through the states

Yale J Biol Med. 1991 Sep-Oct;64(5):443-53.

Abstract

National health program legislation has been becalmed in the Congress for almost 80 years. Despite periodic cries of "crisis," legislation never emerges from committee. Periodically, campaigns have been mounted without success. Tactical efforts to circumvent direct action by legislating bits and pieces of related programs, Medicare and Medicaid, health maintenance organization support, and pre-budgeting, have complicated operation of the medical care system and stimulated intractable cost inflation. For the first 150 years of American history, responsibility for public health and welfare legislation rested with the states. Most public health policies originated in a state or a few states and then later became national legislation. The state efforts were, in effect, natural experiments. After the Depression and the flood of funding from the federal government in subsequent years, the states faded as innovators. It is proposed that funding a few state models to restimulate state initiative in this regard will provide a more effective route to a national health program.

Publication types

  • Historical Article

MeSH terms

  • Animals
  • Financing, Organized / legislation & jurisprudence
  • Health Planning
  • Health Policy / economics
  • Health Policy / history
  • Health Policy / legislation & jurisprudence*
  • History, 20th Century
  • National Health Programs / economics
  • National Health Programs / legislation & jurisprudence*
  • State Government*
  • United States