Overview

Is it morally or politically acceptable to have wide differences in the quality of health care when one crosses a state line? Federalism in the United States has been defended as a political structure that enables people to coexist in a single polity despite deep disagreements about some of the most fundamental aspects of human life. Federalism can create space for difference and latitude for innovation, and its flexibility in levels of policy enactment can allow for fruitful state-level experimentation, especially in the areas of health and health care, which has long been celebrated. However, when federalism results in significant differences in health care availability within a single country, it can generate ethical challenges for health care providers and their patients. These challenges often engender questions of what should be considered an enduring right: Which freedoms should transcend borders? States of Health identifies the practical relevance of federalism to people facing ethical decisions about health and health care, and it considers the theoretical justifications for permissible differences among states. It asks whether authority over important aspects of health is misaligned in the United States today, with some matters problematically left to the states while others are taken over by the federal government.

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Leslie P. Francis is distinguished Alfred C. Emery professor of law, distinguished professor of philosophy, and director of the Center for Law & Biomedical Sciences at the University of Utah. She has been president of the Pacific Division of the American Philosophical Association; cochair of the Privacy, Confidentiality, and Security committee of the National Committee on Vital and Health Statistics; and a member of the Ethics Committee of the American Society for Reproductive Ethics. John G. Francis is professor emeritus of political science at the University of Utah. He publishes in the areas of comparative public policy and electoral politics, regulation, federalism, industrial policy, British electoral choice, and expanding voting access. His comparative work on American and European politics spans topics from environmental policy to health policies such as the trade in organs, HIV testing, and vaccinations for athletes. Linda Jones is an award-winning narrator and NYC actor with a penchant for dark edges and curious truths. Weaned on du Maurier and Hitchcock, Kafka and Poe-tales of mystery, adventure, and intrigue spawned a decades-long career with writers in new work, development, and narration. She has narrated for Penguin Random House, Recorded Books, Audible Studios, and Dreamscape, as well as a variety of independent authors and publishers. She has a BFA from Ithaca College. She lives in Brooklyn with writer John C. Foster and their dog, Coraline, in an apartment filled-to-bursting, floor-to-ceiling, corner-to-absolute-corner with books.

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