that precipitated the transplant decision and controversy to the two- year battle over the Medicaid waiver, state officials have had to contend with the "federal presence."
In this regard it is both ironic and instructive that while the chief architect of the Oregon experiment is a liberal Democrat, so too is its main opponent, Henry Waxman. Waxman, along with Gore and such liberal-oriented interest groups as the Children's Defense Fund and the Catholic Conference, not only opposes what he believes to be the creation of a two-tier health system but also apparently fears that the Oregon reform, which has received positive comment from the Bush administration, will divert attention from a national solution to the Medicaid mess and form a wholesale assault on the current health delivery system in this country. Backers of the Kitzhaber plan in Oregon would be delighted with a national health insurance plan, but argue that until the federal government adopts such a scheme, something about which they are not terribly sanguine, the states should be left to their own devices to deal with existing human hardships growing out of the current program. Among the obstacles facing health care reform in this country, none is more formidable than the fact that the states and the federal government share responsibility for health care but often have different agendas, serve different constituencies, and jealously guard their respective prerogatives. Those who oppose the Oregon experiment have found an ally in federalism, while proponents wring their hands in anguish.
The author would like to acknowledge the assistance of Mark Gibson, Oregon Senate President's Office; Ian Timm, Oregon Health Decisions; and, Jeane Thorne, Oregon Adult and Family Services Division. Portions of this article originally appeared in Daniel M. Fox and Howard M. Leichter, "Rationing Care in Oregon: The New Accountability," Health Affairs 10 (Summer 1991): 7-27. The author wishes to thank Health Affairs for permission to reprint that material.