ABSTRACT
This chapter reviews of policy literature is presented which serves to emphasize the difficulty in analyzing health care reform efforts. It examines the strengths and weaknesses of a number of policy theories. Efforts by the Republican majority in Congress to reform the welfare system while attempting to balance the budget have turned many states into reform activists. The revisionist model is straightforward enough, the central theme being that more governments mean more bureaucracies. Both economists and political scientists have begun to explore the concept of competitive federalism. Some argue that this approach represents a return to dual federalism with added competition among states. Diffusion theory examines the process by which innovations, ideas or polices are spread among members of a social system. While studies concerned with comparative federalism are still relatively rare, political scientists in the United States have continued their attempt to develop an explanatory theory relative to the American federal system.
