Health care law has evolved from the Declaration of Independence, the Bill of Rights and the Constitution. The legislature creates the law while the judiciary will interpret and apply the law. The executive branch has the President and other government agencies they deal mainly with fraud in health care and the safety of drugs consumed. FTC protects health care by investigating violations of the law. The FDA uses a science based regulatory framework that is similar to that used in the regulation of nanotechnology.
Public health programs face more issues because they are larger and disburse large amounts of money. The government is required to show that a health care provider consciously asked for or received compensation after or in a bid to persuade a referral. Sanctions that can come from the False Claims Act include jail time of 5 to 20 years, exclusion from federal programs for health, having one’s assets frozen or lost and paying of fines that can go up to $ 10,000 for each claim among others. Drawbacks to compliance are risk taking and competition. Channel stuffing is the inflation of figures to show more was spent.
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Approximately 44.3 million Americans 11.3% of the population does not have health insurance. Those without insurance have lower incomes. Some of the suggestions to insure the uninsured include offering tax subsidies, reducing the liability and fees paid to lawyers, creating more local health plans and exploring the possibility of bringing in employers. To lower insurance costs encourage the preferred method of treatment which is behavior change. Also, lowering the cost of drugs will lower the cost of healthcare. Tax credits are appealing because they target employers who will accept to provide insurance if they are assured of paying lower taxes. Whereas tax credits to hospitals will avail health care to the least advantaged. Drug companies are also trying to lower the cost of generic drugs.
Most Americans prefer universal health care that provides healthcare to all. ERISA only allows a patient to receive what the treatment cost them but not more to cover any possible future expenses. A state cannot claim for its citizens but others considered third parties can do so claiming the insurer violated against ERISA. Rationing care is challenging because it results in some patient needs not being cared for however, if health care costs are not lowered provision of services is not available at all. It is believed that be able to make better choices and possibly lower costs. Medical necessity is determined by actuarial based guidelines meaning that financial advantage over medical advantage is the guiding factor. As a result, reimbursement will only occur if a claim aligns with the stated guidelines.
