Federalism and Health Care Reform: Is Half a Loaf Really Worse Than None

This Commentary argues that national health care reform that combines federal policy-making and financial assistance with some state administration and implementation may be more likely to achieve the goals of health care reform, and be better for the states and the values of federalism, than either all-federal or states-only reform. New York v. United States does not bar joint federal-state programs. An expansive reading of New York, as Professor Hoke suggests, would limit the development of solutions for the economic and social problems currently besetting the states and thus could, paradoxically, hinder, rather than help, the states in serving as institutions of participation and self-governance for their residents.