The United States has a federalist system: a central government that has
certain powers, with the state as the basic unit of political power. The
allocation of power between the state and federal government has been a point
of contention from the Articles of Confederation to the present day.
Historically, the states retained power over domestic matters. The federal
government was given power over trade between the states and foreign policy
issues. The federal government took greater power over domestic affairs with
the Civil War, and this shifting of power increased during the 1930s as a
result of the constitutional battles over the authority of the federal
government to pass laws designed to end the depression. The civil rights acts
passed in the 1960s and 1970s shifted the balance of power between the state
and federal governments even further. The 1980s saw the federal government
assume more power through mandating entitlement programs (such as Medicare and
Medicaid) while reducing the federal support for these programs.
It is the federal government that determines the extent to which medical
practice regulations will be uniform in the different states. In most areas of
medical practice, the states maintain the central regulatory role. They license
physicians, determine the tort rules under which physicians practice, and put
additional restrictions on federal laws, such as the food and drug laws. This
means that physicians practicing the same specialty in different states have to
modify their practice in accordance with their state's laws.
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