UpDate - Vol. 16, No. 14
December 12, 1996
Health-care reform
Prof's research focuses on federal-state relations

     One of the nation's major issues- if not the major issue-is
health care. As the population increases, as people live longer,
as medicine becomes more sophisticated, complex and expensive, as
the public's expectations and demands grow, and as litigation
becomes more prevalent, health care has undergone some drastic
changes and has become a front-and-center issue in the public-
policy arena.
     Health-care policy and reform and the relationship between
the federal government and the states is the focus of the
research of Marian Lief Palley, political science and
international relations.
     As outgoing president of the Southern Political Science
Association, she delivered the presidential address on this topic
at the organization's annual conference, and her talk, entitled
"Intergovernmentalization of Health Care Reform," will be
published this summer in the Journal of Politics.
     Palley's interest in the politics of health care was
heightened while serving on a committee to launch the Medical
Scholars Program, jointly sponsored by the University and
Jefferson Medical School. "I felt we should include a course on
the topic, and this spring I will teach a class on 'Society,
Politics and Health Care,' " she said.
     She also attended a Salzburg Seminar on medical care for
under- serviced populations.
     In her lecture, Palley discusses the roles of the federal
and state governments in health care. "Although individual states
are undertaking health-care reform, it is within the framework of
federal regulations." Palley said.
     There are two, very different viewpoints about the role of
federal government in health care. On the one hand, states'
rights advocates, insurance companies, health maintenance
organizations, pharmaceutical companies and others are generally
opposed to national regulation.
     On the other, medical practitioners and those receiving
medical care most often favor national regulations. "Medicare and
Medicaid cover a large segment of the population not necessarily
at the poverty level. These individuals and their families are
interested in health issues, are politically active and cannot be
ignored," Palley said.
     Realistically, the amount of federal funding is so large
that the federal government must be involved in regulating health
care, Palley said. For example, in 1994, of the $949.4 billion
spent on health care, the federal government's share was $420.8
billion or more than one third of the health-care tab.
     Delaware has done a fairly good job in the health-care
arena, according to Palley. For those who are in need there is
the Diamond State Plan, which utilizes a managed-care approach
and is designed to treat more patients at lower cost.
     In the future, Palley said she foresees that states will
work out their own health-care agendas but with federal
regulations and oversight.
     As she concludes in her speech and paper, "States, operating
with constraints imposed by intergovernmental regulations, have
been very active in meeting the challenges of health care
reform. But the states cannot pay the bill themselves. The
states are dependent on national dollars. [Although there is]
absent a national political response to the health care delivery
system's runaway costs and unequal distribution of services,
states seem to be filling the gap by responding to the problems
within the constraints imposed by national law."
     Palley, who holds bachelor's and master's degrees from
Syracuse University and a doctorate from New York University, is
the author or coauthor of 10 books and more than 50 articles. Her
most recent books are Women and Public Policies, a new edition of
which has just been issued, and Women of Korea and Japan:
Continuity and Change. She currently serves as president of the
Faculty Senate.
                                              -Sue Swyers Moncure