Title: Medicaid and the limits of state health reform
First published: 1996
Description: With the defeat of national health reform, many liberals have looked to the states as the source of health policy innovation, and many in the new Republican majority also support increased state control. Michael S. Sparer argues that states by themselves cannot satisfy the liberal hope for universal coverage or the conservative hope for cost-containment.

He also points to two critical drawbacks to a state-dominated health care system: the variation in coverage among states and the intergovernmental tension that would accompany such a change.

Sparer analyzes the contradictions in operations between the New York and California Medicaid programs, and questions why New York spends an average of $7,286 on its Medicaid beneficiaries and California an average of $2,801. The answer is rooted in bureaucratic politics. California officials enjoy significant bureaucratic autonomy, while New York officials operate in a decentralized and interest-group dominated environment.

The book supports this conclusion by exploring nursing home and home care policy, hospital care policy, and managed care policy in both states. Sparer's dissection of the consequences of state-based reform makes a persuasive case for national health insurance.
Subjects: States, Medicaid, Health care reform, Sociology, HEALTH & FITNESS, MEDICAL, Policy, Legislation as Topic, Social Sciences, Formal Social Control, Diseases, Government, Social Control Policies, Medical Assistance, Anthropology, Education, Sociology and Social Phenomena, Public Health, Organizations, Health Care Issues, State Government, Economics, Delivery of Health Care, Health Care Delivery, Health Policy, Government Financing, Health Care Economics and Organizations, Organized Financing, Public Policy, Patient Care Management, Health Planning, U.S. states, Health Care Quality, Access, and Evaluation, General, Health Services Administration, Public Assistance, Government policy
Places: United States
LC classification: RA398.A3 S63 1996