Federalism In Healthcare

In reflecting on these questions in the context of what we’ve read and heard in lectures this week, I’m struck by the nature of how we make choices in meeting our healthcare needs as a nation. Ever since our political leaders applied the principles of federalism to their earliest policy-setting efforts, we’ve had counter-balancing factions line up on virtually every aspect of care, from the training of our physicians, to our investments in facilities and technology, how we cover the costs of care, manage research and then deliver care to anyone who needs it. Our options throughout time stem from that early default to federalism—so uniquely American, that state governments’ sovereignty is juxtaposed against the national government, which brings a more global perspective in the ongoing …show more content…
You can’t avoid “downsizing” systems, but if you can redeploy the talent where they are needed, that seems far less disruptive. Planned obsolescence would seem to make sense, as we navigate the future impact of technology on care delivery and migrate people away from unwanted ER use to lower costs. Finally, I’m not sure that it’s directly related, but we must find a way for patients to bear a bit more of the cost of direct care—though not insurance cost. This would bring more transparency that would help policy makers determine how and where to rightsize. The idea that the payer is totally removed from the consumer/patient creates enormous dislocations in the system. Stan Hupfeld, in his TED Talk, spoke eloquently on this subject. It’s like the old Sy Sims clothing retailer’s tagline: “Where our best customers are educated consumers.” So, part of my approach to rightsizing would be to connect more users—patients, physicians and other caregivers—to the payments for use of the