ABSTRACT
Making state choice the core principle of national health reform allows for the decentralized emergence of multiple models of reform. This chapter provides a brief review of the history of failed attempts to enact national health reform. It shows that such reform has been stalemated even at times when congressional majorities apparently favored its adoption. The chapter explains this feature— the inability to translate majority legislative support for the principles of universal health insurance into majority support for any one health reform proposal—to be the primary barrier to national health reform. It proposes solution to this problem: the federalist option of state-led health reform. The chapter outlines what a federalist health reform would look like and discusses the division of responsibility between national and state governments. It addresses the political advantages of the federalist option, as well as criticisms of this approach.
