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134-689: Unlike any other state , the Tennessee Attorney General is an officer of the judicial branch, not the executive branch. Article VI Section 5 of the Tennessee Constitution provides for the appointment of the Attorney General by the justices of the Supreme Court for a term of 8 years. In most other states, the office of attorney general is appointed by the governor or elected by voters or the legislature. The Attorney General oversees

268-437: A general election , they may be held. In all states, the legislatures can remove state executive branch officials, including governors, who have committed serious abuses of their power from office. The process of doing so includes impeachment (the bringing of specific charges), and a trial , in which legislators act as a jury. The primary responsibilities of state legislatures are to enact state laws and appropriate money for

402-485: A republican government known as the Commonwealth of England . Virginia became a royal colony again in 1660, and the word was dropped from the full title; it went unused until reintroduced in 1776. In each state, the chief executive is called the governor, who serves as both head of state and head of government . All governors are chosen by statewide direct election . The governor may approve or veto bills passed by

536-474: A state is a constituent political entity , of which there are 50. Bound together in a political union , each state holds governmental jurisdiction over a separate and defined geographic territory where it shares its sovereignty with the federal government . Due to this shared sovereignty , Americans are citizens both of the federal republic and of the state in which they reside . State citizenship and residency are flexible, and no government approval

670-563: A two-thirds vote in both the House and the Senate, or by a constitutional convention called for by two-thirds of the state legislatures. To become part of the Constitution, an amendment must be ratified by either—as determined by Congress—the legislatures of three-quarters of the states or state ratifying conventions in three-quarters of the states. The vote in each state (to either ratify or reject

804-542: A child born in the US in 2015 is 81.2 (females) or 76.3 (males) years. According to the WHO, life expectancy in the US is 31st in the world (out of 183 countries) as of 2015 . The US's average life expectancy (both sexes) is just over 79. Japan ranks first with an average life expectancy of nearly 84 years. The US ranks lower (36th) when considering health-adjusted life expectancy (HALE) at just over 69 years. Another source,

938-447: A combination of private insurance and various federal and state programs. As of 2017 , health insurance was most commonly acquired through a group plan tied to an employer, covering 150 million people. Other major sources include Medicaid, covering 70 million, Medicare, 50 million, and health insurance marketplaces created by the ACA covering around 17 million. In 2017,

1072-556: A district electing two representatives must have approximately twice the population of a district electing just one. The voting systems used across the nation are: first-past-the-post in single-member districts, and multiple non-transferable vote in multi-member districts. In 2013, there were a total of 7,383 legislators in the 50 state legislative bodies. They earned from $ 0 annually (New Mexico) to $ 90,526 (California). There were various per diem and mileage compensation. States can also organize their judicial systems differently from

1206-521: A few states choose to have the judges on the state's courts serve for life terms. In most states, the judges, including the justices of the highest court in the state, are either elected or appointed for terms of a limited number of years and are usually eligible for re-election or reappointment. All states are unitary states , not federations or aggregates of local governments . Local governments within them are created by and exist by virtue of state law, and local governments within each state are subject to

1340-575: A general regulatory power and undid the Framers' original structure of limited and delegated powers." Subsequently, Congress invoked the Commerce Clause to expand federal criminal legislation, as well as for social reforms such as the Civil Rights Act of 1964 . Only within the past couple of decades, through decisions in cases such as those in U.S. v. Lopez (1995) and U.S. v. Morrison (2000), has

1474-558: A major driver for healthcare reform in the US . As of 2016 , the US spent $ 3.3 trillion (equivalent to $ 4.11 trillion in 2023; 17.9% of GDP), or $ 10,438 (equivalent to $ 13,252 in 2023 ) per person; major categories included 32% on hospital care, 20% on physician and clinical services, and 10% on prescription drugs. In comparison, the United Kingdom spent $ 3,749 (equivalent to $ 4,760 in 2023 ) per person. In 2018, an analysis concluded that prices and administrative costs were largely

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1608-510: A means to retain control of their lands. The proposed constitution ultimately failed in the U.S. Congress. Instead, the Indian Territory and Oklahoma Territory were both incorporated into the new state of Oklahoma in 1907. The first instance occurred while the nation still operated under the Articles of Confederation. The State of Franklin existed for several years, not long after the end of

1742-475: A nationalized healthcare system. A 1978 study argued that “Today every government in the world-including Red China with its squadrons of semi-trained “barefoot doctors”-realizes it has a responsibility to keep its citizens in good physical and mental health. Unlike the U.S., nations like Scandinavia, the U.K., Ireland, Japan and others have opted for a universal health care system in which the state pays everyone's medical bills.” Instead, most citizens are covered by

1876-429: A part in US's international ranking as having the highest healthcare expenditures despite significant patient cost-sharing. Those who are insured may be underinsured such that they cannot afford adequate medical care. A 2003 study estimated that 16 million US adults were underinsured, disproportionately affecting those with lower incomes—73% of the underinsured in the study population had annual incomes below 200% of

2010-466: A presumed felon and arrest by the law officers of one state in another state are often permitted by a state. The full faith and credit expectation does have exceptions, some legal arrangements, such as professional licensure and marriages, may be state-specific, and until recently states have not been found by the courts to be required to honor such arrangements from other states. Such legal acts are nevertheless often recognized state-to-state according to

2144-398: A professional medical degree . In the US, the vast majority of physicians have a Doctor of Medicine (M.D.) degree. Those with Doctor of Osteopathic Medicine (D.O.) degrees get similar training and go through the same MLE steps as MD's and so are also allowed to use the title "physician". As in most other countries, the manufacture and production of pharmaceuticals and medical devices

2278-543: A proposed amendment) carries equal weight, regardless of a state's population or length of time in the Union. U.S. states are not sovereign in the Westphalian sense in international law which says that each State has sovereignty over its territory and domestic affairs, to the exclusion of all external powers, on the principle of non-interference in another State's domestic affairs, and that each State (no matter how large or small)

2412-491: A relatively more cost effective rate of a societal cost of $ 327,000 to $ 867,000 (equivalent to $ 415,143 to $ 1.1 million in 2023 ) per life saved compared to other public policies which cost an average of $ 7.6 million (equivalent to $ 9.65 million in 2023 ) per life. A 2009 study in five states found that medical debt contributed to 46.2% of all personal bankruptcies , and 62.1% of bankruptcy filers claimed high medical expenses in 2007. Since then, health costs and

2546-587: A shift in healthcare. The American Medical Association (AMA) worked to standardize medical education, and the introduction of employer-sponsored insurance plans marked the beginning of the modern health insurance system. More people were starting to get involved in healthcare like state actors, other professionals/practitioners, patients and clients, the judiciary, and business interests and employers. They had interest in medical regulations of professionals to ensure that services were provided by trained and educated people to minimize harm. The post–World War II era saw

2680-532: A significant expansion in healthcare where more opportunities were offered to increase accessibility of services. The passage of the Hill–Burton Act in 1946 provided federal funding for hospital construction, and Medicare and Medicaid were established in 1965 to provide healthcare coverage to the elderly and low-income populations, respectively. The healthcare system in the United States can be traced back to

2814-497: A smaller upper house, in all states called the Senate. The exception is the unicameral Nebraska Legislature , meaning it has only a single chamber. Most states have a part-time legislature (traditionally called a citizen legislature ). Ten state legislatures are considered full-time ; these bodies are more similar to the U.S. Congress than are the others. Members of each state's legislature are chosen by direct election. In Baker v. Carr (1962) and Reynolds v. Sims (1964),

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2948-501: A statistical brief by the Healthcare Cost and Utilization Project (HCUP), there were 35.7 million hospitalizations in 2016, a significant decrease from the 38.6 million in 2011. For every 1,000 in the population, there was an average of 104.2 stays and each stay averaged $ 11,700 (equivalent to $ 14,854 in 2023 ), an increase from the $ 10,400 (equivalent to $ 13,802 in 2023 ) cost per stay in 2012. Approximately 7.6% of

3082-412: A study estimated that nearly half of hospital-associated care resulted from emergency department visits. As of 2017 , data from 2009–2011 showed that end-of-life care in the last year of life accounted for about 8.5%, and the last three years of life about 16.7%. As of 2013 , administration of healthcare constituted 30% of US healthcare costs. Free-market advocates claim that the healthcare system

3216-483: A study found that 73% of plans on ACA marketplaces had narrow networks, limiting access and choice in providers. Healthcare coverage is provided through a combination of private health insurance and public health coverage (e.g., Medicare, Medicaid). In 2013, 64% of health spending was paid for by the government, and funded via programs such as Medicare , Medicaid , the Children's Health Insurance Program , Tricare , and

3350-487: A study reported obesity-related deaths have surged in the United States in recent years, particularly among men, according to new data published in The American Journal of Cardiology. The study noted that while the age-adjusted mortality rate has increased due to obesity, deaths related to cardiovascular disease, including ischemic heart disease and heart failure, have actually decreased. Healthcare providers in

3484-472: A territory has. When the people of a territory make their desire for statehood known to the federal government, Congress may pass an enabling act authorizing the people of that territory to organize a constitutional convention to write a state constitution as a step toward admission to the Union. Each act details the mechanism by which the territory will be admitted as a state following ratification of their constitution and election of state officers. Although

3618-508: A trend of high rates of underinsurance and wage stagnation contributed to a healthcare consumption decline for low-income Americans. This trend was reversed after the implementation of the major provisions of the ACA in 2014. As of 2017 , the possibility that the ACA may be repealed or replaced has intensified interest in the questions of whether and how health insurance coverage affects health and mortality. Several studies have indicated that there

3752-573: A usual source of medical care, visiting the dentist yearly, rates of preventable hospitalizations, reported difficulty seeing a specialist, delaying care due to cost, and rates of health insurance coverage. In 2004, an OECD report noted that "all OECD countries [except Mexico, Turkey, and the US] had achieved universal or near-universal (at least 98.4% insured) coverage of their populations by 1990". The 2004 IOM report also observed that "lack of health insurance causes roughly 18,000 unnecessary deaths every year in

3886-451: Is "dysfunctional" because the system of third-party payments from insurers removes the patient as a major participant in the financial and medical choices that affect costs. The Cato Institute claims that because government intervention has expanded insurance availability through programs such as Medicare and Medicaid, this has exacerbated the problem. According to a study paid for by America's Health Insurance Plans (a Washington lobbyist for

4020-442: Is a common way for individuals to obtain coverage. The complex nature of the system, as well as its high costs, has led to ongoing discussions about the future of healthcare in the United States. At the same time, the United States is a global leader in medical innovation, measured either in terms of revenue or the number of new drugs and medical devices introduced. The Foundation for Research on Equal Opportunity concluded that

4154-533: Is an association with expansion of the ACA and factors associated with better health outcomes such as having a regular source of care and the ability to afford care. A 2016 study concluded that an approximately 60% increased ability to afford care can be attributed to Medicaid expansion provisions enacted by the Patient Protection and Affordable Care Act. Additionally, an analysis of changes in mortality post Medicaid expansion suggests that Medicaid saves lives at

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4288-529: Is carried out by private companies. The research and development of medical devices and pharmaceuticals is supported by both public and private sources of funding. In 2003, research and development expenditures were approximately $ 95 billion (equivalent to $ 151 billion in 2023 ) with $ 40 billion (equivalent to $ 63.5 billion in 2023 ) coming from public sources and $ 55 billion (equivalent to $ 87.3 billion in 2023 ) coming from private sources. These investments into medical research have made

4422-433: Is designed to test whether medical students can apply their medical skills and knowledge to actual clinical practice during students' fourth year of medical school. The third step is done after the first year of residency. It tests whether students can apply medical knowledge to the unsupervised practice of medicine. The American College of Physicians , uses the term "physician" to describe all medical practitioners holding

4556-527: Is equal in international law. Additionally, the 50 U.S. states do not possess international legal sovereignty, meaning that they are not recognized by other sovereign States such as, for example, France, Germany or the United Kingdom. The federal government is responsible for international relations , but state and local government leaders do occasionally travel to other countries and form economic and cultural relationships. Article IV also grants to Congress

4690-474: Is in the shorter lifespan of men, but, even after adjustment for age (assuming men live as long as women), there still is a 20% difference in lifetime healthcare expenditures. Unlike most developed nations , the US health system does not provide healthcare to the country's entire population. In 1977, the United States was said to be the only industrialized country not to have some form of national health insurance or direct healthcare provision to citizens through

4824-605: Is no nationwide system of government-owned medical facilities open to the general public but there are local government-owned medical facilities open to the general public. The US Department of Defense operates field hospitals as well as permanent hospitals via the Military Health System to provide military-funded care to active military personnel. The federal Veterans Health Administration operates VA hospitals open only to veterans, though veterans who seek medical care for conditions they did not receive while serving in

4958-400: Is required to move between states , except for persons restricted by certain types of court orders (such as paroled convicts and children of divorced spouses who share child custody ). State governments in the U.S. are allocated power by the people (of each respective state) through their individual state constitutions . All are grounded in republican principles (this being required by

5092-502: Is required to give full faith and credit to the acts of each other's legislatures and courts, which is generally held to include the recognition of most contracts and criminal judgments, and before 1865, slavery status. Under the Extradition Clause , a state must extradite people located there who have fled charges of "treason, felony, or other crimes" in another state if the other state so demands. The principle of hot pursuit of

5226-542: Is the nationwide legal drinking age of 21, enacted by each state, brought about by the National Minimum Drinking Age Act . Although some objected that this infringes on states' rights, the Supreme Court upheld the practice as a permissible use of the Constitution's Spending Clause in South Dakota v. Dole 483 U.S. 203 (1987). As prescribed by Article I of the Constitution, which establishes

5360-461: The 2010 census . Each state is entitled to a number of electors equal to the total number of representatives and senators from that state; the District of Columbia is entitled to three electors. While the Constitution does set parameters for the election of federal officials, state law, not federal, regulates most aspects of elections in the U.S., including primaries, the eligibility of voters (beyond

5494-534: The COVID-19 pandemic . In 2019, the under-five child mortality rate was 6.5 deaths per 1000 live births, placing the US 33rd of 37 OECD countries. While not as high in 2015 (14) as in 2013 (18.5), maternal deaths related to childbirth have shown recent increases; in 1987, the mortality ratio was 7.2 per 100,000. As of 2015 , the US rate is double the maternal mortality rate in Belgium or Canada, and more than triple

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5628-469: The Colonial Era . Community-oriented care was typical, with families and neighbors providing assistance to the sick. During the 19th century, the practice of medicine began to professionalize, following the “Anglo-American model” where these new medical professionals were empowered by the state to govern their own affairs, leading to various collaborations to acquire status and win legislation granting them

5762-725: The Constitution of Alabama , contained 310,296 words, which is more than 40 times as many as the U.S. Constitution . In practice, each state has adopted a three-branch frame of government: executive, legislative, and judicial (even though doing so has never been required). Early in American history, four state governments differentiated themselves from the others in their first constitutions by choosing to self-identify as Commonwealths rather than as states : Virginia , in 1776; Pennsylvania , in 1777; Massachusetts , in 1780; and Kentucky , in 1792. Consequently, while these four are states like

5896-527: The Constitution of the United States . In relation to the states, the U.S. Constitution elaborated concepts of federalism . Under U.S. constitutional law, the 50 individual states and the United States as a whole are each sovereign jurisdictions. The states are not administrative divisions of the country; the Tenth Amendment to the United States Constitution reserves to the states or to

6030-455: The District of Columbia indirectly elect the president and vice president . When casting ballots in presidential elections they are voting for presidential electors , who then, using procedures provided in the 12th amendment , elect the president and vice president. There were 538 electors for the most recent presidential election in 2020 ; the allocation of electoral votes was based on

6164-584: The Lee Resolution and signing the United States Declaration of Independence . Prior to these events each state had been a British colony ; each then joined the first Union of states between 1777 and 1781, upon ratifying the Articles of Confederation , the first U.S. constitution. Also during this period, the newly independent states developed their own individual state constitutions , among

6298-702: The United States Constitution . States and their citizens are represented in the United States Congress , a bicameral legislature consisting of the Senate and the House of Representatives . Each state is also entitled to select a number of electors (equal to the total number of representatives and senators from that state) to vote in the Electoral College , the body that directly elects the president of

6432-702: The Veterans Health Administration . People aged under 65 acquire insurance via their or a family member's employer, by purchasing health insurance on their own, getting government and/or other assistance based on income or another condition, or are uninsured. Health insurance for public sector employees is primarily provided by the government in its role as employer. Managed care , where payers use various techniques intended to improve quality and limit cost, has become ubiquitous. Measures of accessibility and affordability tracked by national health surveys include: percent of population with insurance, having

6566-716: The WHO , total healthcare spending in the US was 18% of its GDP in 2011, the highest in the world. The Health and Human Services Department expects that the health share of GDP will continue its historical upward trend, reaching 19% of GDP by 2017. Of each dollar spent on healthcare in the US, 31% goes to hospital care, 21% goes to physician/clinical services, 10% to pharmaceuticals, 4% to dental, 6% to nursing homes and 3% to home healthcare, 3% for other retail products, 3% for government public health activities, 7% to administrative costs, 7% to investment, and 6% to other professional services (physical therapists, optometrists, etc.). In 2017,

6700-494: The federal judiciary , as long as they protect the federal constitutional right of their citizens to procedural due process . Most have a trial-level court, generally called a district court , superior court or circuit court , a first-level appellate court , generally called a court of appeal (or appeals), and a supreme court . Oklahoma and Texas have separate highest courts for criminal appeals. Uniquely, in New York State,

6834-448: The 1990s. In 2015, the total number of deaths by heart disease was 633,842, by cancer it was 595,930, and from chronic lower respiratory disease it was 155,041. In 2015, 267.18 deaths per 100,000 people were caused by cardiovascular diseases, 204.63 by neoplasms and 100.66 by neurological disorders. Diarrhea, lower respiratory, and other common infections were ranked sixth overall, but had the highest rate of infectious disease mortality in

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6968-462: The 20th century saw continued evolution in healthcare policy, technology, and delivery. Following the Stabilization Act of 1942 , employers, unable to provide higher salaries to attract or retain employees, began to offer insurance plans, including healthcare packages , as a benefit in kind , thereby beginning the practice of employer-sponsored health insurance, a practice that is cemented into

7102-669: The American Revolution, but was never recognized by the Confederation Congress, which ultimately recognized North Carolina 's claim of sovereignty over the area. The territory comprising Franklin later became part of the Southwest Territory, and ultimately of the state of Tennessee. Additionally, the entry of several states into the Union was delayed due to distinctive complicating factors. Among them, Michigan Territory , which petitioned Congress for statehood in 1835,

7236-535: The COVID-19 pandemic, but still trails behind peer and rival countries including Canada, China and Germany. Death certificate data from the CDC reveals that mortality rates among children and adolescents increased by 11% for the years 2019 and 2020 and a further 8% for 2020 and 2021, with injuries being a driving factor, along with homicide, suicide, drug overdoses and motor vehicle accidents impacting those aged 10 to 19. In 2024

7370-591: The Central Intelligence Agency, indicates life expectancy at birth in the US is 79.8, ranking it 42nd in the world. Monaco is first on this list of 224, with an average life expectancy of 89.5. A 2013 National Research Council study stated that, when considered as one of 17 high-income countries , the US was at or near the top in infant mortality, heart and lung disease, sexually transmitted infections , adolescent pregnancies , injuries, homicides, and rates of disability . Together, such issues place

7504-420: The Constitution has been amended, and the interpretation and application of its provisions have changed. The general tendency has been toward centralization and incorporation , with the federal government playing a much larger role than it once did. There is a continuing debate over states' rights , which concerns the extent and nature of the states' powers and sovereignty in relation to the federal government and

7638-409: The Constitution mandated admission of new states on the basis of equality. With the consent of Congress, states may enter into interstate compacts , agreements between two or more states. Compacts are frequently used to manage a shared resource, such as transportation infrastructure or water rights. Under Article IV of the Constitution , which outlines the relationship between the states, each state

7772-634: The Constitution. A state, unlike the federal government, has un-enumerated police power , that is, the right to generally make all necessary laws for the welfare of its people. As a result, while the governments of the various states share many similar features, they often vary greatly with regard to form and substance. No two state governments are identical. The government of each state is structured in accordance with its individual constitution, all of which are written constitutions. Many of these documents are more detailed and more elaborated than their federal counterpart. For example, before its revision in 2022,

7906-614: The Court tried to limit the Commerce Clause power of Congress. Another enumerated congressional power is its taxing and spending power . An example of this is the system of federal aid for highways, which include the Interstate Highway System . The system is mandated and largely funded by the federal government and serves the interests of the states. By threatening to withhold federal highway funds, Congress has been able to pressure state legislatures to pass various laws. An example

8040-549: The European Union, and four times as many as the United Kingdom. A major impending demographic shift in the US will require the healthcare system to provide more care, as the older population is predicted to increase medical expenses by 5% or more in North America due to the "baby boomers" reaching retirement age. The overall spending on healthcare has increased since the late 1990s, and not just due to general price raises as

8174-505: The House—presently 435 voting members—is set by federal statute . Seats in the House are distributed among the states in proportion to the most recent constitutionally mandated decennial census . The borders of these districts are established by the states individually through a process called redistricting , and within each state all districts are required to have approximately equal populations. Citizens in each state plus those in

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8308-546: The Supreme Court in U.S. v. Darby upheld the Fair Labor Standards Act of 1938 , holding that Congress had the power under the Commerce Clause to regulate employment conditions. Then, one year later, in Wickard v. Filburn , the Court expanded federal power to regulate the economy by holding that federal authority under the commerce clause extends to activities which may appear to be local in nature but in reality effect

8442-605: The U.S. Congress, each state is represented in the Senate (irrespective of population size) by two senators, and each is guaranteed at least one representative in the House. Both senators and representatives are chosen in direct popular elections in the various states. (Prior to 1913, senators were elected by state legislatures.) There are presently 100 senators, who are elected at-large to staggered terms of six years, with one-third of them being chosen every two years. Representatives are elected at large or from single-member districts to terms of two years (not staggered). The size of

8576-405: The U.S. Healthcare System. Government-funded healthcare facilities especially have a large reliance on these NPs due to the amount of services they are required to provide. Services, particularly urgent-care services, may also be delivered remotely via telemedicine by providers such as Teladoc . Besides government and private healthcare facilities, there are also 355 registered free clinics in

8710-515: The U.S. Supreme Court held that all states are required to elect their legislatures in such a way as to afford each citizen the same degree of representation (the one person, one vote standard). In practice, most states elect legislators from single-member districts , each of which has approximately the same population. Some states, such as Maryland and Vermont, divide the state into single- and multi-member districts. In this case, multi-member districts must have proportionately larger populations, e.g.,

8844-615: The U.S. have died by suicide. Cumulative poverty of ten years or more is the fourth leading risk factor for mortality in the United States annually. Since 2020, the Centers for Disease Control and Prevention (CDC) reports that the life expectancy for the US population was 77.0 years, a decrease of 1.8 years from 2019. Life expectancy fell again in 2021 to 76.4 years, which has been attributed to COVID-19 and rising death rates from suicide, drug overdoses and liver disease. As of 2023, U.S. life expectancy has increased slightly following

8978-419: The US at 31.65 deaths per 100,000 people. There is evidence, however, that a large proportion of health outcomes and early mortality can be attributed to factors other than communicable or non-communicable disease. As a 2013 National Research Council study concluded, more than half the men who die before the age of 50 die due to murder (19%), traffic accidents (18%), and other accidents (16%). For women,

9112-578: The US at the bottom of the list for life expectancy in high-income countries. Females born in the US in 2015 have a life expectancy of 81.6 years, and males 76.9 years; more than three years less and as much as over five years less than people born in Switzerland (85.3 F, 81.3 M) or Japan (86.8 F, 80.5 M) in 2015. The top three causes of death among both sexes and all ages in the US have consistently remained cardiovascular diseases (ranked 1st), neoplasms (2nd) and neurological disorders (3rd), since

9246-724: The US encompass individual healthcare personnel, healthcare facilities, and medical products. In the US, ownership of the healthcare system is now mainly in private hands, though federal, state, county, and city governments also own certain facilities. As of 2018 , there were 5,534 registered hospitals in the US. There were 4,840 community hospitals, which are defined as nonfederal, short-term general, or specialty hospitals. The nonprofit hospitals share of total hospital capacity has remained relatively stable (about 70%) for decades. There are also privately owned for-profit hospitals as well as government hospitals in some locations, mainly owned by county and city governments. The Hill–Burton Act

9380-507: The US that provide limited medical services. They are considered to be part of the social safety net for those who lack health insurance. Their services may range from more acute care (i.e., STIs, injuries, respiratory diseases) to long term care (i.e. dentistry, counseling). Another component of the healthcare safety net would be federally funded community health centers . Other healthcare facilities include long-term housing facilities which, as of 2019 , there were 15,600 nursing homes across

9514-508: The US the leader in medical innovation, measured either in terms of revenue or the number of new drugs and devices introduced. In 2016, the research and development spending by pharmaceutical companies in the US was estimated to be around $ 59 billion (equivalent to $ 73.5 billion in 2023 ). In 2006, the US accounted for three quarters of the world's biotechnology revenues and 82% of world R&D spending in biotechnology. According to multiple international pharmaceutical trade groups,

9648-462: The US". A 2009 study done at Harvard Medical School with Cambridge Health Alliance by cofounders of Physicians for a National Health Program , a pro-single payer lobbying group, showed that nearly 45,000 annual deaths are associated with a lack of patient health insurance. The study also found that uninsured, working Americans have an approximately 40% higher mortality risk compared to privately insured working Americans. The Gallup organization tracks

9782-470: The US, with a large portion of that number being for-profit (69.3%) In 2022, 19 hospitals filed for bankruptcy, closed, or announced plans to close. Physicians in the US include those trained by the US medical education system, and those that are international medical graduates who have progressed through the necessary steps to acquire a medical license to practice in a state. This includes going through

9916-401: The US. Common reasons for seeking these alternative approaches included improving their well-being, engaging in a transformational experience, gaining more control over their own health, or finding a better way to relieve symptoms caused by chronic disease. They aim to treat not just physical illness but fix its underlying nutritional, social, emotional, and spiritual causes. In a 2008 survey, it

10050-650: The United States . Additionally, each state has the opportunity to ratify constitutional amendments , and, with the consent of Congress, two or more states may enter into interstate compacts with one another. The police power of each state is also recognized. Historically, the tasks of local law enforcement , public education , public health , intrastate commerce regulation, and local transportation and infrastructure , in addition to local, state, and federal elections , have generally been considered primarily state responsibilities, although all of these now have significant federal funding and regulation as well. Over time,

10184-634: The United States Congress. Puerto Rico has limited representation in the U.S. House of Representatives in the form of a Resident Commissioner , a delegate with limited voting rights in the Committee of the Whole House on the State of the Union , but no voting rights otherwise. A non-binding referendum on statehood, independence, or a new option for an associated territory (different from the current status)

10318-426: The United States dominates science and technology, which "was on full display during the COVID-19 pandemic , as the U.S. government [delivered] coronavirus vaccines far faster than anyone had ever done before", but lags behind in fiscal sustainability, with "[government] spending ... growing at an unsustainable rate". In the early 20th century, advances in medical technology and a focus on public health contributed to

10452-443: The administration of public policy. In all states, if the governor vetoes a bill (or a portion of one), it can still become law if the legislature overrides the veto (repasses the bill), which in most states requires a two-thirds vote in each chamber. In 49 of the 50 states the legislature consists of two chambers: a lower house (variously called the House of Representatives, State Assembly, General Assembly or House of Delegates) and

10586-402: The authority to admit new states into the Union. Since the establishment of the United States in 1776, the number of states has expanded from the original 13 to 50. Each new state has been admitted on an equal footing with the existing states. Article IV also forbids the creation of new states from parts of existing states without the consent of both the affected states and Congress. This caveat

10720-442: The basic constitutional definition), the running of each state's electoral college, as well as the running of state and local elections. All elections—federal, state, and local—are administered by the individual states, and some voting rules and procedures may differ among them. Article V of the Constitution accords states a key role in the process of amending the U.S. Constitution. Amendments may be proposed either by Congress with

10854-1055: The cause of the high costs, including prices for labor, pharmaceuticals, and diagnostics. The combination of high prices and high volume can cause particular expense; in the US, high-margin high-volume procedures include angioplasties , C-sections , knee replacements , and CT and MRI scans; CT and MRI scans also showed higher utilization in the US. Aggregate US hospital costs were $ 387.3 billion in 2011—a 63% increase since 1997 (inflation adjusted). Costs per stay increased 47% since 1997, averaging $ 10,000 in 2011 (equivalent to $ 13,544 in 2023 ). As of 2008 , public spending accounts for between 45% and 56% of US healthcare spending. Surgical, injury, and maternal and neonatal health hospital visit costs increased by more than 2% each year from 2003–2011. Further, while average hospital discharges remained stable, hospital costs rose from $ 9,100 in 2003 (equivalent to $ 15,072 in 2023 ) to $ 10,600 in 2011 (equivalent to $ 14,357 in 2023 ) and were projected to be $ 11,000 by 2013 (equivalent to $ 14,388 in 2023 ). According to

10988-450: The central authority of that particular state. State governments commonly delegate some authority to local units and channel policy decisions down to them for implementation. In a few states, local units of government are permitted a degree of home rule over various matters. The prevailing legal theory of state preeminence over local governments, referred to as Dillon's Rule , holds that, A municipal corporation possesses and can exercise

11122-458: The common practice of comity . States are prohibited from discriminating against citizens of other states with respect to their basic rights , under the Privileges and Immunities Clause . Under Article IV, each state is guaranteed a form of government that is grounded in republican principles, such as the consent of the governed . This guarantee has long been at the forefront of the debate about

11256-480: The democratic will of the United States citizens residing in Puerto Rico as expressed in the plebiscites held on November 6, 2012, and June 11, 2017, by setting forth the terms for the admission of the territory of Puerto Rico as a state of the Union. The act has 37 original cosponsors between Republicans and Democrats in the U.S. House of Representatives. On November 3, 2020, Puerto Rico held another referendum . In

11390-435: The earliest written constitutions in the world. Although different in detail, these state constitutions shared features that would be important in the American constitutional order: they were republican in form, and separated power among three branches, most had bicameral legislatures, and contained statements, or a bill, of rights. Later, from 1787 to 1790, each of the states also ratified a new federal frame of government in

11524-413: The early 20th century, the Supreme Court's interpretation of this " Commerce Clause " has, over time, greatly expanded the scope of federal power , at the expense of powers formerly considered purely states' matters. The Cambridge Economic History of the United States says, "On the whole, especially after the mid-1880s, the Court construed the Commerce Clause in favor of increased federal power." In 1941,

11658-400: The entire national economy and are therefore of national concern. For example, Congress can regulate railway traffic across state lines, but it may also regulate rail traffic solely within a state, based on the reality that intrastate traffic still affects interstate commerce. Through such decisions, argues law professor David F. Forte, "the Court turned the commerce power into the equivalent of

11792-514: The existence of the powers. Each state defines for itself what powers it will allow local governments. Generally, four categories of power may be given to local jurisdictions: Each state admitted to the Union by Congress since 1789 has entered it on an equal footing with the original states in all respects. With the growth of states' rights advocacy during the antebellum period , the Supreme Court asserted, in Lessee of Pollard v. Hagan (1845), that

11926-505: The federal constitution), and each provides for a government, consisting of three branches, each with separate and independent powers : executive , legislative , and judicial . States are divided into counties or county-equivalents, which may be assigned some local governmental authority but are not sovereign. County or county-equivalent structure varies widely by state, and states also create other local governments . States, unlike U.S. territories , possess many powers and rights under

12060-407: The federal government, or part of one, before being admitted to the Union. Three were set off from an already existing state, two entered the Union after having been sovereign states , and one was established from unorganized territory : Congress is under no obligation to admit states, even in those areas whose population expresses a desire for statehood. Such has been the case numerous times during

12194-429: The federal poverty level. Lack of insurance or higher cost sharing (user fees for the patient with insurance) create barriers to accessing healthcare: use of care declines with increasing patient cost-sharing obligation. Before the ACA passed in 2014, 39% of below-average income Americans reported forgoing seeing a doctor for a medical issue (whereas 7% of low-income Canadians and 1% of low-income British citizens reported

12328-406: The following powers and no others: First, those granted in express words; second, those necessarily implied or necessarily incident to the powers expressly granted; third, those absolutely essential to the declared objects and purposes of the corporation—not simply convenient but indispensable; fourth, any fair doubt as to the existence of power is resolved by the courts against the corporation—against

12462-664: The health insurance industry) and carried out by PriceWaterhouseCoopers, increased utilization is the primary driver of rising healthcare costs in the US The study cites numerous causes of increased utilization, including rising consumer demand, new treatments, more intensive diagnostic testing, lifestyle factors, the movement to broader-access plans, and higher-priced technologies. The study also mentions cost-shifting from government programs to private payers. Low reimbursement rates for Medicare and Medicaid have increased cost-shifting pressures on hospitals and doctors, who charge higher rates for

12596-411: The high cost of patented drugs in the US has encouraged substantial reinvestment in such research and development. Though, the ACA will force industry to sell medicine at a cheaper price. Due to this, it is possible budget cuts will be made on research and development of human health and medicine in the US. In 2022, the United States had 10,265 drugs in the works, more than twice as many as China and

12730-717: The military are charged for services. The Indian Health Service (IHS) operates facilities open only to Native Americans from recognized tribes. These facilities, plus tribal facilities and privately contracted services funded by IHS to increase system capacity and capabilities, provide medical care to tribespeople beyond what can be paid for by any private insurance or other government programs. Hospitals provide some outpatient care in their emergency rooms and specialty clinics, but primarily exist to provide inpatient care. Hospital emergency departments and urgent care centers are sources of sporadic problem-focused care. Surgicenters are examples of specialty clinics. Hospice services for

12864-583: The nation's history. In one instance, Mormon pioneers in Salt Lake City sought to establish the state of Deseret in 1849. It existed for slightly over two years and was never approved by the United States Congress . In another, leaders of the Five Civilized Tribes (Cherokee, Chickasaw, Choctaw, Creek, and Seminole) in Indian Territory proposed to establish the state of Sequoyah in 1905, as

12998-467: The non-binding referendum, Puerto Ricans voted in favor of becoming a state. They also voted for a pro-statehood governor , Pedro Pierluisi . Health care in the United States Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance , and out-of-pocket payments . The U.S. is

13132-421: The numbers of uninsured and underinsured have increased. A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses. In practice, the uninsured are often treated, but the cost is covered through taxes and other fees which shift the cost. Forgone medical care due to extensive cost sharing may ultimately increase costs due to downstream medical issues; this dynamic may play

13266-432: The only developed country without a system of universal healthcare , and a significant proportion of its population lacks health insurance . The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across

13400-509: The other states, each is formally a commonwealth because the term is contained in its constitution. The term, commonwealth , which refers to a state in which the supreme power is vested in the people , was first used in Virginia during the Interregnum , the 1649–60 period between the reigns of Charles I and Charles II during which parliament's Oliver Cromwell as Lord Protector established

13534-473: The people all powers of government not delegated to the federal government. Consequently, each of the 50 states reserves the right to organize its individual government in any way (within the broad parameters set by the U.S. Constitution and the Republican Guarantee enforced by Congress) deemed appropriate by its people, and to exercise all powers of government not delegated to the federal government by

13668-525: The people independently of the governor—such as the lieutenant governor , attorney general , comptroller , secretary of state , and others. Elections of officials in the United States are generally for a fixed term of office. The constitutions of 19 states allow for citizens to remove and replace an elected public official before the end of their term of office through a recall election . Each state follows its own procedures for recall elections, and sets its own restrictions on how often, and how soon after

13802-565: The percent of adult Americans who are uninsured for healthcare, beginning in 2008. The rate of uninsured peaked at 18.0% in 2013 prior to the ACA mandate, fell to 10.9% in the third quarter of 2016, and stood at 13.7% in the fourth quarter of 2018. "The 2.8-percentage-point increase since that low represents a net increase of about seven million adults without health insurance." The US Census Bureau reported that 28.5 million people (8.8%) did not have health insurance in 2017, down from 49.9 million (16.3%) in 2010. Between 2004 and 2013,

13936-465: The percentages are different: 53% of women who die before the age of 50 die due to disease, whereas 38% die due to accidents, homicide, and suicide. Diseases of despair (drug overdoses, alcoholic liver disease, and suicide), which started increasing in the early 1990s, kill roughly 158,000 Americans a year as of 2018 . Suicides reached record levels in the United States in 2022, with nearly 49,500 suicide deaths. Since 2011, around 540,000 people in

14070-496: The population had overnight stays in 2017, each stay lasting an average of 4.6 days. A study by the National Institutes of Health reported that the lifetime per capita expenditure at birth, using the year 2000 dollars, showed a large difference between the healthcare costs of females ($ 361,192, equivalent to $ 639,048 in 2023 ) and males ($ 268,679, equivalent to $ 475,367 in 2023 ). A large portion of this cost difference

14204-790: The population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare . The U.S. healthcare system has been the subject of significant political debate and reform efforts, particularly in the areas of healthcare costs, insurance coverage, and the quality of care. Legislation such as the Affordable Care Act of 2010 has sought to address some of these issues, though challenges remain. Uninsured rates have fluctuated over time, and disparities in access to care exist based on factors such as income, race , and geographical location. The private insurance model predominates, and employer-sponsored insurance

14338-701: The power to secede from the Union, shortly after the Civil War (1861–1865), the U.S. Supreme Court , in Texas v. White , held that a state cannot unilaterally do so. The 50 U.S. states, in alphabetical order, along with each state's flag: The 13 original states came into existence in July 1776 during the American Revolutionary War (1775–1783), as the successors of the Thirteen Colonies , upon agreeing to

14472-437: The power to self-regulate. The establishment of medical schools and professional organizations led to standardized training and certification processes for doctors. Despite this progress, healthcare services remained disparate, particularly between urban and rural areas. The concept of hospitals as institutions for the sick began to take root, leading to the foundation of many public and private hospitals. The latter part of

14606-432: The process to admit Puerto Rico as a state. Another status referendum was held on June 11, 2017, in which 97% percent of voters chose statehood. Turnout was low, as only 23% of voters went to the polls, with advocates of both continued territorial status and independence urging voters to boycott it. On June 27, 2018, the H.R. 6246 Act was introduced on the U.S. House with the purpose of responding to, and comply with,

14740-625: The rate in the Finland as well as several other Western European countries. In 2019, Black maternal health advocate and Parents writer Christine Michel Carter interviewed Vice President Kamala Harris . As a senator, in 2019 Harris reintroduced the Maternal Care Access and Reducing Emergencies (CARE) Act which aimed to address the maternal mortality disparity faced by women of color by training providers on recognizing implicit racial bias and its impact on care. Harris stated: We need to speak

14874-752: The rate of spending is growing faster than the rate of inflation. Moreover, the expenditure on health services for people over 45 years old is 8.3 times the maximum of that of those under 45 years old. Other methods of medical treatment are being practiced more frequently than before. This field is labeled Complementary and Alternative Medicine (CAM) and are defined as therapies generally not taught in medical school nor available in hospitals. They include herbs , massages, energy healing, homeopathy , faith healing , and, more recently popularized, cryotherapy , cupping , and Transcranial Magnetic Stimulation or TMS. Providers of these CAM treatments are sometimes legally considered healthcare providers in

15008-487: The rights of citizens vis-à-vis the government. States are also guaranteed protection from invasion, and, upon the application of the state legislature (or executive, if the legislature cannot be convened), from domestic violence. This provision was discussed during the 1967 Detroit riot but was not invoked. The Supremacy Clause ( Article VI, Clause 2 ) establishes that the Constitution , federal laws made pursuant to it, and treaties made under its authority, constitute

15142-425: The rights of individuals. The Constitution grants to Congress the authority to admit new states into the Union. Since the establishment of the United States in 1776 by the Thirteen Colonies , the number of states has expanded from the original 13 to 50. Each new state has been admitted on an equal footing with the existing states. While the Constitution does not explicitly discuss the issue of whether states have

15276-490: The risk in an attempt to provide value-based healthcare , have grown in popularity. Regional areas have separate healthcare markets, and in some markets competition is limited as the demand from the local population cannot support multiple hospitals. About two-thirds of doctors practice in small offices with less than seven physicians, with over 80% owned by physicians; these sometimes join groups such as independent practice associations to increase bargaining power. There

15410-404: The same). The US life expectancy in 2010 was 78.6 years at birth, up from 75.2 years in 1990; this ranks 42nd among 224 nations, and 22nd out of the 35 OECD countries, down from 20th in 1990. In 2021, US life expectancy fell to 76.4 years, the shortest in roughly two decades. Drivers for this drop in life expectancy include accidents, drug overdoses , heart and liver disease, suicides and

15544-415: The state legislature, as well as recommend and work for the passage of bills, usually supported by their political party. In 44 states, governors have line item veto power. Most states have a plural executive , meaning that the governor is not the only government official in the state responsible for its executive branch . In these states, executive power is distributed amongst other officials, elected by

15678-484: The states admitted to the Union after the original 13 were formed from an organized territory established and governed by Congress in accord with its plenary power under Article IV, Section 3, Clause 2 . The outline for this process was established by the Northwest Ordinance (1787), which predates the ratification of the Constitution. In some cases, an entire territory has become a state; in others some part of

15812-514: The states. The Tenth Amendment reserves all other powers to the states, or to the people. Powers of the U.S. Congress are enumerated in Article I, Section 8 , for example, the power to declare war. Making treaties is one power forbidden to the states, being listed among other such powers in Article I, Section 10 . Among the Article I enumerated powers of Congress is the power to regulate commerce. Since

15946-414: The supreme law of the land. It provides that state courts are bound by the supreme law; in case of conflict between federal and state law, the federal law must be applied. Even state constitutions are subordinate to federal law. States' rights are understood mainly with reference to the Tenth Amendment . The Constitution delegates some powers to the national government, and it forbids some powers to

16080-412: The terminally ill who are expected to live six months or less are most commonly subsidized by charities and government. Prenatal, family planning , and dysplasia clinics are government-funded obstetric and gynecologic specialty clinics respectively, and are usually staffed by nurse practitioners. Because of the robust skills credited to nurse practitioners (NPs) they are able to address disparities in

16214-546: The three steps of the US Medical Licensing Examination (USMLE). The first step of the USMLE tests whether medical students both understand and are capable of applying the basic scientific foundations to medicine after the second year of medical school. The topics include: anatomy, biochemistry, microbiology , pathology, pharmacology, physiology, behavioral sciences , nutrition, genetics , and aging. The second step

16348-467: The total number of judges across all state courts is about 30,000—for comparison, 1 million new cases are filed each year in federal courts, which have about 1,700 judges. Most states base their legal system on English common law (with substantial statutory changes and incorporation of certain civil law innovations), with the notable exception of Louisiana, a former French colony , which draws large parts of its legal system from French civil law . Only

16482-614: The trial court is called the Supreme Court ; appeals go up first to the Supreme Court's Appellate Division , and from there to its highest court, the New York Court of Appeals . State court systems exercise broad, plenary, and general jurisdiction, in contrast to the federal courts, which are courts of limited jurisdiction. The overwhelming majority of criminal and civil cases in the United States are heard in state courts. Each year, roughly 30 million new cases are filed in state courts and

16616-580: The uncomfortable truth that women—and especially Black women—are too often not listened to or taken seriously by the health care system, and therefore they are denied the dignity that they deserve. And we need to speak this truth because today, the United States is 1 of only 13 countries in the world where the rate of maternal mortality is worse than it was 25 years ago. That risk is even higher for Black women, who are three to four times more likely than white women to die from pregnancy-related causes. These numbers are simply outrageous. Life expectancy at birth for

16750-436: The use of an enabling act is a traditional historic practice, a number of territories have drafted constitutions for submission to Congress absent an enabling act and were subsequently admitted. Upon acceptance of that constitution and meeting any additional congressional stipulations, Congress has always admitted that territory as a state. In addition to the original 13, six subsequent states were never an organized territory of

16884-549: The work and operations of the Office of the Attorney General. In this capacity, he is assisted by various office heads. Chief Deputy Attorney General - Lacey E. Mase Solicitor General - Andreé Sophia Blumstein Chief of Staff - Brandon J. Smith This Tennessee -related article is a stub . You can help Misplaced Pages by expanding it . State (U.S.) In the United States ,

17018-410: The work culture of today. The Health Maintenance Organization Act of 1973 encouraged the development of managed care, while advances in medical technology revolutionized treatment. In the 21st century, the Affordable Care Act (ACA) was passed in 2010, extending healthcare coverage to millions of uninsured Americans and implementing reforms aimed at improving quality and reducing costs. According to

17152-520: Was also delayed over slavery and was settled when it agreed to adopt a gradual abolition plan. Puerto Rico , an unincorporated U.S. territory , refers to itself as the " Commonwealth of Puerto Rico" in the English version of its constitution , and as "Estado Libre Asociado" (literally, Associated Free State) in the Spanish version. As with all U.S. territories, its residents do not have full representation in

17286-425: Was designed to give Eastern states that still had Western land claims (including Georgia, North Carolina, and Virginia), to have a veto over whether their western counties could become states, and has served this same function since, whenever a proposal to partition an existing state or states in order that a region within might either join another state or to create a new state has come before Congress. Most of

17420-416: Was found that 37% of hospitals in the US offer at least one form of CAM treatment, the main reason being patient demand (84% of hospitals). Costs for CAM treatments average $ 33.9 (equivalent to $ 49.81 in 2023 ) with two-thirds being out-of-pocket, according to a 2007 statistical analysis. Moreover, CAM treatments covered 11.2% of total out-of-pocket payments on healthcare. During 2002 to 2008, spending on CAM

17554-620: Was held on November 6, 2012. Sixty one percent (61%) of voters chose the statehood option, while one third of the ballots were submitted blank. On December 11, 2012, the Legislative Assembly of Puerto Rico enacted a concurrent resolution requesting the President and the Congress of the United States to respond to the referendum of the people of Puerto Rico, held on November 6, 2012, to end its current form of territorial status and to begin

17688-481: Was not admitted to the Union until 1837, due to a boundary dispute with the adjoining state of Ohio. The Republic of Texas requested annexation to the United States in 1837, but fears about potential conflict with Mexico delayed the admission of Texas for nine years. Statehood for Kansas Territory was held up for several years (1854–61) due to a series of internal violent conflicts involving anti-slavery and pro-slavery factions. West Virginia's bid for statehood

17822-458: Was on the rise, but usage has since plateaued to about 40% of adults in the US The US spends more as a percentage of GDP than similar countries, and this can be explained either through higher prices for services themselves, higher costs to administer the system, or more utilization of these services, or to a combination of these elements. Healthcare costs rising far faster than inflation have been

17956-399: Was passed in 1946, which provided federal funding for hospitals in exchange for treating poor patients. The largest hospital system in 2016 by revenue was HCA Healthcare ; in 2019, Dignity Health and Catholic Health Initiatives merged into CommonSpirit Health to create the largest by revenue, spanning 21 states. Integrated delivery systems , where the provider and the insurer share

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