129-460: The United States federal executive departments are the principal units of the executive branch of the federal government of the United States . They are analogous to ministries common in parliamentary or semi-presidential systems but (the United States being a presidential system ) they are led by a head of government who is also the head of state . The executive departments are
258-640: A U.S. citizen for at least seven years, and must live in the state that they represent. In addition to the 435 voting members, there are six non-voting members, consisting of five delegates and one resident commissioner . There is one delegate each from Washington, D.C. , Guam , the Virgin Islands , American Samoa , the Commonwealth of the Northern Mariana Islands , and a resident commissioner from Puerto Rico . Unlike
387-548: 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,
516-450: 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,
645-707: A complex set of relationships between state and federal courts. Federal courts can sometimes hear cases arising under state law pursuant to diversity jurisdiction , state courts can decide certain matters involving federal law, and a handful of federal claims are primarily reserved by federal statute to the state courts. Both court systems have exclusive jurisdiction in some areas and concurrent jurisdiction in others. The U.S. Constitution safeguards judicial independence by providing that federal judges shall hold office "during good behavior"; in practice, this usually means they serve until they die, retire, or resign. A judge who commits an offense while in office may be impeached in
774-523: A constitutional interpretation by the courts. One of the theoretical pillars of the U.S. Constitution is the idea of " checks and balances " among the powers and responsibilities of the three branches of American government: the executive, the legislative, and the judiciary. For example, while the legislative branch ( Congress ) has the power to create law, the executive branch under the president can veto any legislation—an act which, in turn, can be overridden by Congress. The president nominates judges to
903-613: A few cases. The judicial power extends to cases arising under the Constitution, an Act of Congress ; a U.S. treaty ; cases affecting ambassadors , ministers and consuls of foreign countries in the U.S.; cases and controversies to which the federal government is a party; controversies between states (or their citizens) and foreign nations (or their citizens or subjects); and bankruptcy cases (collectively "federal-question jurisdiction"). The Eleventh Amendment removed from federal jurisdiction cases in which citizens of one state were
1032-565: 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
1161-615: A more limited role for the central government in relation to individuals, the states, or other recognized entities. Since the American Civil War , the powers of the federal government have generally expanded greatly, although there have been periods since that time of legislative branch dominance (e.g., the decades immediately following the Civil War) or when states' rights proponents have succeeded in limiting federal power through legislative action, executive prerogative or by
1290-475: 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
1419-429: 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
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#17327579174531548-402: 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 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
1677-398: 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
1806-491: 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
1935-587: 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
2064-476: 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
2193-478: A single elected term." Under the Presentment Clause of Article I, a bill that passes both chambers of Congress shall be presented to the president, who may sign the bill into law or veto the bill by returning it to the chamber where it originated. If the president neither signs nor vetoes a bill "within ten Days (Sundays excepted) after it shall have been presented to him" it becomes a law without
2322-508: 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
2451-504: A strong separation of powers , the federal Constitution's Ineligibility Clause expressly prohibits executive branch employees (including heads of executive departments) from simultaneously serving in Congress , and vice versa. Accordingly, in sharp contrast to virtually all other Western democracies (parliamentary systems) where ministers are selected to form a government from members of parliament , U.S. legislators who are appointed by
2580-412: 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
2709-488: 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
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#17327579174532838-496: 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
2967-511: 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
3096-576: 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
3225-451: 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
3354-442: 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
3483-541: 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
3612-426: Is based on the principles of federalism and republicanism , in which power is shared between the federal government and state governments . The interpretation and execution of these principles, including what powers the federal government should have and how those powers can be exercised, have been debated ever since the adoption of the Constitution. Some make a case for expansive federal powers while others argue for
3741-529: 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
3870-433: 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
3999-474: 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
United States federal executive departments - Misplaced Pages Continue
4128-615: 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
4257-569: Is sometimes used. The terms "Federal" and "National" in government agency or program names generally indicate affiliation with the federal government; for instance, the Federal Bureau of Investigation , National Oceanic and Atmospheric Administration , and National Park Service . Because the seat of government is in Washington, D.C. , "Washington" is sometimes used as a metonym for the federal government. The United States government
4386-412: Is the name that appears on money, in treaties, and in legal cases to which the nation is a party. The terms "Government of the United States of America" or "United States Government" are often used in official documents to represent the federal government as distinct from the states collectively. In casual conversation or writing, the term "Federal Government" is often used, and the term "U.S. Government"
4515-544: 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
4644-475: 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
4773-508: The Senate . The U.S. House of Representatives is made up of 435 voting members, each of whom represents a congressional district in a state from where they were elected. Apportionment of seats among the 50 states is determined by state populations, and it is updated after each decennial U.S. Census. Each member serves a two-year term. In order to be elected as a representative, an individual must be at least 25 years of age, must have been
4902-526: The Supreme Court , combat piracies and felonies , declare war , raise and support armies , provide and maintain a navy , make rules for the regulation of land and naval forces, provide for, arm and discipline the militia , exercise exclusive legislation in the District of Columbia , regulate interstate commerce , and to make laws necessary to properly execute powers. Over the two centuries since
5031-494: The U.S. Senate , all members of the U.S. House must be elected and cannot be appointed. In the case of a vacancy, the seat must be filled through a special election, as required under Article 1 of the U.S. Constitution. In contrast, the Senate is made up of two senators from each state, regardless of population. There are currently 100 senators (2 from each of the 50 states), who each serve six-year terms. Approximately one-third of
5160-463: The U.S. Supreme Court . In the federal division of power, the federal government shares sovereignty with each of the 50 states in their respective territories. U.S. law recognizes Indigenous tribes as possessing sovereign powers , while being subject to federal jurisdiction. The full name of the republic is the "United States of America". No other name appears in the Constitution , and this
5289-532: The U.S. Tax Court , are specialized courts handling only certain kinds of cases, known as subject matter jurisdiction . The Bankruptcy Courts are supervised by the district courts, and, as such, are not considered part of the Article III judiciary. As such, their judges do not have lifetime tenure, nor are they Constitutionally exempt from diminution of their remuneration. The Tax Court is an Article I Court, not an Article III Court. The district courts are
United States federal executive departments - Misplaced Pages Continue
5418-505: The United States District Courts , which are the general trial courts for federal law, and for certain controversies between litigants who are not deemed citizens of the same state, known as diversity jurisdiction . There are three levels of federal courts with general jurisdiction, which are courts that handle both criminal and civil suits between individuals. Other courts, such as the bankruptcy courts and
5547-914: The United States Postal Service (USPS), NASA , the Central Intelligence Agency (CIA), the Environmental Protection Agency (EPA), and the United States Agency for International Development (USAID). In addition, there are government-owned corporations , including the Federal Deposit Insurance Corporation and the National Railroad Passenger Corporation . The Judiciary, under Article III of
5676-660: The United States Senate , and serve at the pleasure of the president . The heads of departments are members of the Cabinet of the United States , an executive organ that normally acts as an advisory body to the president. In the Opinion Clause (Article II, section 2, clause 1) of the U.S. Constitution , heads of executive departments are referred to as "principal Officer in each of the executive Departments". The heads of executive departments are included in
5805-714: 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
5934-719: 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,
6063-713: The White House staff, the National Security Council , the Office of Management and Budget , the Council of Economic Advisers , the Council on Environmental Quality , the Office of the U.S. Trade Representative , the Office of National Drug Control Policy , and the Office of Science and Technology Policy . Outside of the EOP and the executive departments are a number of independent agencies . These include
6192-630: The head of government (the chief executive). The Constitution directs the president to " take care that the laws be faithfully executed " and requires the president to swear or affirm to "preserve, protect and defend the Constitution of the United States." Legal scholars William P. Marshall and Saikrishna B. Prakash write of the Clause: "the President may neither breach federal law nor order their subordinates to do so, for defiance cannot be considered faithful execution. The Constitution also incorporates
6321-582: The line of succession to the president, in the event of a vacancy in the presidency, after the vice president , the speaker of the House , and the president pro tempore of the Senate . They are included in order of their respective department's formation, with the exception of the Secretary of Defense, whose position in the line of succession is based on when the Department of War was formed. To enforce
6450-448: 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
6579-470: 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
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#17327579174536708-543: 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
6837-886: The Cabinet who are appointed by the president. These are the White House Chief of Staff, Administrator of the Environmental Protection Agency, Director of the Office of Management & Budget, United States Trade Representative, U.S. Ambassador to the United Nations, Chairman of the Council of Economic Advisers, and Administrator of the Small Business Administration. The heads of the 15 departments are chosen by
6966-602: 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
7095-643: The Constitution, explains and applies the laws. This branch does this by hearing and eventually making decisions on various legal cases. Article III section I of the Constitution establishes the Supreme Court of the United States and authorizes the United States Congress to establish inferior courts as their need shall arise. Section I also establishes a lifetime tenure for all federal judges and states that their compensation may not be diminished during their time in office. Article II section II establishes that all federal judges are to be appointed by
7224-593: The English bars on dispensing or suspending the law, with some supposing that the Clause itself prohibits both." Many presidential actions are undertaken via executive orders , presidential proclamations , and presidential memoranda . The president is the commander-in-chief of the armed forces . Under the Reception Clause , the president is empowered to "receive Ambassadors and other public Ministers";
7353-627: 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
7482-525: The House plus its two senators). The District of Columbia has a number of electoral votes "equal to the whole number of Senators and Representatives in Congress to which the District would be entitled if it were a State, but in no event more than the least populous State". A President may also be seated by succession . As originally drafted, there was no limit to the time a President could serve, however
7611-837: The President alone, in the Courts of Law, or in the Heads of Departments." These appointments delegate "by legal authority a portion of the sovereign powers of the federal government." The Constitution grants the president the "Power to grant Reprieves and Pardons for Offences against the United States , except in Cases of Impeachment"; this clemency power includes the power to issue absolute or conditional pardons, and to issue commute sentences , to remit fines, and to issue general amnesties . The presidential clemency power extends only to federal crimes, and not to state crimes. The president has informal powers beyond their formal powers. For example,
7740-439: The Senate stands for election every two years. If a vacancy occurs, the state governor appoints a replacement to complete the term or to hold the office until a special election can take place. The House and Senate each have particular exclusive powers. For example, the Senate must approve (give " advice and consent " to) many important presidential appointments, including cabinet officers, federal judges (including nominees to
7869-479: The Supreme Court), department secretaries (heads of federal executive branch departments), U.S. military and naval officers, and ambassadors to foreign countries. All legislative bills for raising revenue must originate in the House of Representatives. The approval of both chambers is required to pass all legislation, which then may only become law by being signed by the president (or, if the president vetoes
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#17327579174537998-493: The Twenty-second Amendment, ratified in 1951, originally limits any president to serving two four-year terms (8 years); the amendment specifically "caps the service of a president at 10 years" by providing that "if a person succeeds to the office of president without election and serves less than two years, he may run for two full terms; otherwise, a person succeeding to office of president can serve no more than
8127-405: 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
8256-620: 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
8385-419: 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,
8514-584: 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
8643-724: 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
8772-507: 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
8901-508: 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,
9030-462: 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
9159-473: 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
9288-401: 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
9417-554: 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 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
9546-426: 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
9675-525: The United States was formed, many disputes have arisen over the limits on the powers of the federal government. These disputes have often been the subject of lawsuits that have ultimately been decided by the United States Supreme Court . Congressional oversight is intended to prevent waste and fraud, protect civil liberties and individual rights, ensure executive compliance with the law, gather information for making laws and educating
9804-648: The United States#Executive branch [REDACTED] [REDACTED] The federal government of the United States ( U.S. federal government or U.S. government ) is the common government of the United States , a federal republic located primarily in North America , comprising 50 states , five major self-governing territories , several island possessions , and the federal district (national capital) of Washington, D.C. , where
9933-482: The administrative arms of the president of the United States . There are currently 15 executive departments. Each department is headed by a secretary whose title echoes the title of their respective department, with the exception of the Department of Justice , whose head is known as the attorney general . The heads of the executive departments are appointed by the president and take office after confirmation by
10062-458: The bill, both houses of Congress then re-pass the bill, but by a two-thirds majority of each chamber, in which case the bill becomes law without the president's signature). The powers of Congress are limited to those enumerated in the Constitution; all other powers are reserved to the states and the people. The Constitution also includes the Necessary and Proper Clause , which grants Congress
10191-402: The case from state court to federal court. The United States Courts of Appeals are appellate courts that hear appeals of cases decided by the district courts, and some direct appeals from administrative agencies, and some interlocutory appeals. The U.S. Supreme Court hears appeals from the decisions of the courts of appeals or state supreme courts, and in addition has original jurisdiction over
10320-1055: 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
10449-404: The chambers to consider urgent matters. The vice president is the second-highest official in rank of the federal government. The vice president's duties and powers are established in the legislative branch of the federal government under Article 1, Section 3, Clauses 4 and 5 as the president of the Senate ; this means that they are the designated presiding officer of the Senate. In that capacity,
10578-544: The consent of two-thirds of the Senate. Article II's Appointments Clause provides that the president "shall nominate, and by and with the Advice and Consent of the Senate, shall appoint Ambassadors, other public Ministers and Consuls, Judges of the supreme Court, and all other Officers of the United States " while providing that "Congress may by Law vest the Appointment of such inferior Officers, as they think proper, in
10707-492: The domain of state governments (i.e., education , health and welfare services , housing , and transportation ), Congress frequently authorized only funding for grants which were voluntary, in the sense that state or local government agencies could choose to apply for such grants (and accept conditions attached by Congress) or they could decline to apply. In the case of HHS's Medicare program, Congress chose to contract with private health insurers because they "already possessed
10836-572: The economy. In addition, each house may name special, or select, committees to study specific problems. Today, much of the congressional workload is borne by the subcommittees, of which there are around 150. The Constitution grants numerous powers to Congress. Enumerated in Article I, Section 8, these include the powers to levy and collect taxes ; to coin money and regulate its value; provide for punishment for counterfeiting; establish post offices and roads, issue patents, create federal courts inferior to
10965-418: The executive branch when becoming president upon the death, resignation, or removal of the president, which has happened nine times in U.S. history. Lastly, in the case of a Twenty-fifth Amendment succession event, the vice president would become acting president, assuming all of the powers and duties of president, except being designated as president. Accordingly, by circumstances, the Constitution designates
11094-429: 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
11223-668: 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
11352-411: 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
11481-486: The law and creating precedent for future law and decisions. The United States Constitution does not specifically mention the power of judicial review , which is the power to declare a law unconstitutional. There have been instances in the past where such declarations have been ignored by the other two branches. Below the U.S. Supreme Court are the United States Courts of Appeals , and below them in turn are
11610-448: The majority of the federal government is based. The U.S. federal government is composed of three distinct branches: legislative , executive , and judicial , whose powers are vested by the U.S. Constitution in the Congress , the president , and the federal courts , respectively. The powers and duties of these branches are further defined by acts of Congress, including the creation of executive departments and courts subordinate to
11739-717: 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
11868-477: The nation's highest judiciary authority, the Supreme Court (as well as to lower federal courts), but those nominees must be approved by Congress. The Supreme Court, in turn, can invalidate unconstitutional laws passed by the Congress. The United States Congress , under Article I of the Constitution, is the legislative branch of the federal government. It is bicameral , comprising the House of Representatives and
11997-421: 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
12126-702: The office of vice president. Article II, Section 2 of the Constitution sets forth the creation of a presidential Cabinet. The role of the Cabinet is to advise the president and carry out the programs and laws of the federal government. The Cabinet is composed of the vice president and the leaders of 15 executive departments. Those executive departments are the Departments of State, Treasury, Defense, Justice, Interior, Agriculture, Commerce, Labor, Health and Human Services, Housing and Urban Development, Transportation, Energy, Education, Veterans Affairs, and Homeland Security. Additionally, there are seven other members of
12255-403: The official. Then, a trial is held in the Senate to decide whether the official should be removed from office. As of 2023 , three presidents have been impeached: Andrew Johnson , Bill Clinton , and Donald Trump (twice). None of the three were removed from office following trial in the Senate. Article I, Section 2, paragraph 2 of the U.S. Constitution gives each chamber the power to "determine
12384-565: 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,
12513-465: 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
12642-488: The plaintiffs and the government of another state was the defendant. It did not disturb federal jurisdiction in cases in which a state government is a plaintiff and a citizen of another state the defendant. The power of the federal courts extends both to civil actions for damages and other redress, and to criminal cases arising under federal law. The interplay of the Supremacy Clause and Article III has resulted in
12771-505: 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
12900-543: The power to "make all laws which shall be necessary and proper for carrying into execution the foregoing powers". Members of the House and Senate are elected by first-past-the-post voting in every state except Louisiana and Georgia , which have runoffs , and Maine and Alaska , which use ranked-choice voting . Congress has the power to remove the president, federal judges, and other federal officers from office. The House of Representatives and Senate have separate roles in this process. The House must first vote to impeach
13029-497: The power to adjourn Congress whenever the House and Senate cannot agree when to adjourn; no president has ever used this power. The president also has the constitutional power to, "on extraordinary Occasions, convene both Houses, or either of them"; this power has been used "to consider nominations, war, and emergency legislation." This Section invests the President with the discretion to convene Congress on "extraordinary occasions"; this special session power that has been used to call
13158-558: The power to re-organize or even abolish federal courts lower than the Supreme Court. The U.S. Supreme Court decides cases and controversies , which include matters pertaining to the federal government, disputes between states, and interpretation of the United States Constitution, and, in general, can declare legislation or executive action made at any level of the government as unconstitutional , nullifying
13287-437: 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
13416-502: The president and approved with the "advice and consent" of the U.S. Senate. Once confirmed, these "Cabinet secretaries" serve at the pleasure of the president. In addition to the executive departments, a number of staff organizations are grouped into the Executive Office of the President (EOP), which was created in 1939 by President Franklin D. Roosevelt. The EOP is overseen by the White House Chief of Staff. The EOP includes
13545-588: The president and confirmed by the Senate to serve as heads of executive departments must resign from Congress before assuming their new positions. If the emoluments for a new appointee's executive branch position were increased while the appointee was previously serving in Congress (e.g., cost of living adjustments), the president must implement a Saxbe fix . As is evident from the chart below, several executive departments (Education, Health and Human Services, Housing and Urban Development, and Transportation) have disproportionately small employee headcounts in contrast to
13674-485: The president and confirmed by the United States Senate. The Judiciary Act of 1789 subdivided the nation jurisdictionally into judicial districts and created federal courts for each district. The three tiered structure of this act established the basic structure of the national judiciary: the Supreme Court, 13 courts of appeals, 94 district courts, and two courts of special jurisdiction. Congress retains
13803-543: The president has broad authority to conduct foreign relations, is generally considered to have the sole power of diplomatic recognition , and is the United States' chief diplomat, although the Congress also has an important role in legislating on foreign affairs, and can, for example, "institute a trade embargo, declare war upon a foreign government that the President had recognized, or decline to appropriate funds for an embassy in that country." The president may also negotiate and sign treaties, but ratifying treaties requires
13932-474: The president has major agenda-setting powers to influence lawmaking and policymaking, and typically has a major role as the leader of their political party . The president and vice president are normally elected as running mates by the Electoral College ; each state has a number of electoral votes equal to the size of its Congressional delegation ( i.e. , its number of Representatives in
14061-525: The president's signature, "unless the Congress by their Adjournment prevent its Return in which Case it shall not be a Law" (called a pocket veto ). A presidential veto may be overridden by a two-thirds vote in both houses of Congress; this occurs relatively infrequently. The president may be impeached by a majority in the House and removed from office by a two-thirds majority in the Senate for " treason , bribery , or other high crimes and misdemeanors ". The president may not dissolve Congress , but has
14190-501: The public, and evaluate executive performance. It applies to cabinet departments, executive agencies, regulatory commissions, and the presidency. Congress's oversight function takes many forms: The executive branch is established in Article Two of the United States Constitution , which vests executive power in the president of the United States . The president is both the head of state (performing ceremonial functions) and
14319-639: 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
14448-752: 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
14577-517: The requisite expertise for administering complex health insurance programs", and because American hospitals preferred to continue dealing with private insurers instead of a new federal bureaucracy. [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] [REDACTED] Federal government of
14706-490: 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
14835-477: The rules of its proceedings". From this provision were created congressional committees , which do the work of drafting legislation and conducting congressional investigations into national matters. The 118th Congress (2023–2025) has 20 standing committees in the House and 19 in the Senate, plus 4 joint permanent committees with members from both houses overseeing the Library of Congress , printing, taxation, and
14964-425: The same way as the president or other officials of the federal government. U.S. judges are appointed by the president, subject to confirmation by the Senate. Another Constitutional provision prohibits Congress from reducing the pay of any present Article III judge. However, Congress is able to set a lower salary for all future judges who take office after such a pay reduction is passed by Congress. Healthcare in
15093-404: 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
15222-439: The size of their budgets. This is because many of their employees merely supervise contracts with private independent contractors or grants (especially categorical grants ) to state or local government agencies who are primarily responsible for providing services directly to the general public. In the 20th century, when the federal government began to provide funding and supervision for matters which were historically seen as
15351-579: 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
15480-412: 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
15609-563: 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
15738-529: The trial courts wherein cases that are considered under the Judicial Code (Title 28, United States Code) consistent with the jurisdictional precepts of federal question jurisdiction , diversity jurisdiction, and pendent jurisdiction can be filed and decided. The district courts can also hear cases under removal jurisdiction , wherein a case brought in a state court meets the requirements for diversity jurisdiction, and one party litigant chooses to "remove"
15867-580: 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
15996-518: The vice president as routinely in the legislative branch, or succeeding to the executive branch as president, or possibly being in both as acting president pursuant to the Twenty-fifth Amendment . Because of circumstances, the overlapping nature of the duties and powers attributed to the office, the title of the office and other matters, such has generated a spirited scholarly dispute regarding attaching an exclusive branch designation to
16125-522: The vice president has the authority ( ex officio , for they are not an elected member of the Senate) to cast a tie-breaking vote . Pursuant to the Twelfth Amendment , the vice president presides over the joint session of Congress when it convenes to count the vote of the Electoral College . As first in the U.S. presidential line of succession , the vice president's duties and powers move to
16254-410: 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
16383-416: 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
16512-463: 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
16641-399: 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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