Health Affairs
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RESEARCH ARTICLE
HEALTH AFFAIRSVOL. 2, NO. 4
The Role of State and Local Government In Health
Drew E. Altman and Douglas H. Morgan
PUBLISHED:WINTER 1983Free Accesshttps://doi.org/10.1377/hlthaff.2.4.7
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ABSTRACT
PROLOGUE:
As a consequence of the taxpayer's revolt that began in California and spread across the country, sharp cutbacks in federal aid to subnational levels of government, and the economic recession, state and local governments are being forced to cope with dramatically reduced resources. Nevertheless, spending for health remains big business in state and local governments today. More than one of every six dollars states spend (16.9percent) are devoted to health, slightly more than the share of the federal budget devoted to health (13 percent). Local governments spend 7.8 percent of their overall expenditures for health purposes, a proportion roughly equal to that of transportation, public safety, and natural resources and more than spending for public welfare. Recognizing that resources are shrinking at a time when responsibilities are expanding, Drew Altman and Douglas Morgan have a particular interest as officers at The Robert Wood Johnson Foundation in developing policy approaches to this difficult equation that spare the most vulnerable population segments of society. Altman, an assistant vice-president at the foundation, is a political scientist by training (Ph.D., Massachusetts Institute of Technology) and former health official in the Carter administration. Morgan, a senior program officer at the foundation who holds a master's degree in public administration from New York University, was formerly the City of Newark's director of public health. Two decades ago, Altman and Morgan would have been in the forefront of the Great Society, believing as they do in a strong central government. Now, realists that they are, Altman and Morgan are struggling, along with many others, to strike new balances, build new alliances, and make tough decisions in the face of limited resources. As they underscore, these judgments will involve incremental changes rather than fundamental funding reallocations or policy shifts. Despite the incremental nature of the shifts, though, it is unlikely that ever again will state and local governments be cast so easily as the adversaries of the poor—they now represent a vast resource to people without means.
