A New Approach To The State-Federal Relationship In Health
The dynamics of this important relationship must change, even before major reform proposals are put forward or enacted.
Federal health policy making is too often shaped by mistrust of states on fiscal and programmatic matters. The current approach of micromanaging state decisions undermines the dynamism necessary to administer and improve Medicaid. The new Obama administration should commit to healing the state-federal relationship through greater policy transparency and by developing a robust, performance-oriented approach to Medicaid program oversight. The administration should undertake additional joint federal-state efforts to address other health policy priorities. These steps would lay a stronger platform on which efforts for comprehensive health reform can be built.
[Health Affairs 28, no. 2 (2009): w188–w193]
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
