The structure of the US legislative system responsible for enacting large-scale health legislation has pros and cons that are currently actively debated ("legal system" refers to the system of court procedures and processes overseen by an independent judge and responsible for interpreting civil law and common law [Cornell Law School]). One significant pro for the structure of our legislative system's ability to enact large-scale health legislation is that the individual's right to the pursuit of happiness, which is generally seen as including prosperity, is protected. This means that medical professionals can practice medicine how they want and at what price for services they want. One oft discussed con against the structure of our legislative system's ability to enact large-scale health legislation is that since the medical industry is protected, certain individuals are left without adequate recourse to health care, sometimes at great harm to their physical well being and quality of life. Another pro for our system's ability to enact large-scale health legislation is that, in our federalist republic, individual states are more free to enact legislation according to their own assessment of and perspective on need. Medical marijuana offers a perfect example of this as some states, such as California, Montana and Texas, have legalized medical marijuana while others, like Idaho, Kansas and Nebraska, haven't (as of July 2018, NCSL). Another con against our system's ability to enact large-scale health legislation is that our health care delivery system "has not produced superlative health outcomes for its people" (ncbi.nlm.nih.gov). A corollary to this is the con that the US is one of less than a half-dozen highly developed countries that haven't enacted large-scale health legislation to provide universal health care coverage (world health care map, The Atlantic).
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Although many of the obstacles to health care reform are grounded in political will, entrenched interests, and legislative gridlock, there are several ways in which the legal system impacts the ability to reform healthcare.
Perhaps the most overwhelming obstacle to healthcare reform on a national level is federalism and the issue of states' rights. The greatest cost efficiencies in health care reform can be found in national systems that can develop economies of scale in everything from data processing to purchasing. If the US federal government negotiated, for example, pricing for prescription medication, it could reduce their costs significantly while still allowing pharmaceutical companies adequate margins to support research and development. Having funding and benefits vary from state to state with a complex mixture of different systems such as the public Medicare, Medicaid, Veteran's Administration, and private insurance with various public subsidies is needlessly complex and expensive in terms of overhead costs. On the other hand, many "blue" states have been able to experiment with new models of health care funding and access and have been significantly more agile than the federal government.
The next obstacle to reform involves regulation and licensing. For example, nurse practitioners can offer basic family health care considerably less expensively than physicians. They have the ability to fill in gaps in health care availability for underserved populations in poor or rural areas. Scope of Practice laws, however, limit their ability to offer care and often make it more expensive. Ongoing reforms to these laws can help reduce costs and increase access to health care.
Laws passed by conservative Republicans to restrict abortion and attacks on Planned Parenthood limit the ability to expand affordable family planning and women's health care. Laws designed to reduce services for and deport illegal immigrants also have a negative impact on health care. This is because public health depends on preventing or treating communicable diseases in entire populations. Offering free and accessible health care to everyone on US soil, no matter whether they are immigrants, visitors, or citizens, prevents the spread of diseases. Laws which insist that students are vaccinated as a condition of school attendance have had a strong positive effect on public health.
Finally, malpractice laws encourage doctors to practice defensively rather than effectively, often ordering tests that are not needed or overmedicating. On the other hand, public disclosure laws have a strong positive effect on physician performance.
https://www.amnhealthcare.com/latest-healthcare-news/limits-nurse-practitioner-practice-current-future-trends/
https://www.ncbi.nlm.nih.gov/books/NBK236545/
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