Well, in Australia, our universal healthcare program, Medicare is run by the Federal Government, with public hospitals coming under state control. G.P's act basically like pseudo-contractors, with their own independent practices supplemented by government subsides, such as bulk-billing, which make the service (in the case of a doctors visit) free for the patient.
That may change soon though, the Australian Health and Hospital Reform Commission released a report regarding reform of the national health care system here, and recommended that the Federal Government take control of some of the hospital services that the states are supposed to provide. (And it also looks like we're going to have a universal dental care system too, yay)
However, this is all constitutional here, the Federal Government was given the power to do that with a constitutional amendment in 1946. Amendments to the constitution here are done via referendum.
In the United States does an amendment to the constitution need to be put forth to the popular vote, or can legislation just be passed though the house and senate?
Constitutional Amendments - The U.S. Constitution Online - USConstitution.net
The Amendment Process
There are essentially two ways spelled out in the Constitution for how to propose an amendment. One has never been used.
The first method is for a bill to pass both houses of the legislature, by a two-thirds majority in each. Once the bill has passed both houses, it goes on to the states. This is the route taken by all current amendments. Because of some long outstanding amendments, such as the 27th, Congress will normally put a time limit (typically seven years) for the bill to be approved as an amendment (for example, see the 21st and 22nd).
The second method prescribed is for a Constitutional Convention to be called by two-thirds of the legislatures of the States, and for that Convention to propose one or more amendments. These amendments are then sent to the states to be approved by three-fourths of the legislatures or conventions. This route has never been taken, and there is discussion in political science circles about just how such a convention would be convened, and what kind of changes it would bring about.
Regardless of which of the two proposal routes is taken, the amendment must be ratified, or approved, by three-fourths of states. There are two ways to do this, too. The text of the amendment may specify whether the bill must be passed by the state legislatures or by a state convention. See the Ratification Convention Page for a discussion of the make up of a convention. Amendments are sent to the legislatures of the states by default. Only one amendment, the 21st, specified a convention. In any case, passage by the legislature or convention is by simple majority.
The Constitution, then, spells out four paths for an amendment:
•Proposal by convention of states, ratification by state conventions (never used)
•Proposal by convention of states, ratification by state legislatures (never used)
•Proposal by Congress, ratification by state conventions (used once)
•Proposal by Congress, ratification by state legislatures (used all other times)
It is interesting to note that at no point does the President have a role in the formal amendment process (though he would be free to make his opinion known). He cannot veto an amendment proposal, nor a ratification. This point is clear in Article 5, and was reaffirmed by the Supreme Court in Hollingsworth v Virginia (3 US 378 [1798]):
You mean for the federal gov't to mandate the states? No way in Hell. Congress has twisted arms in the past, by holding up some type of funding pending some action by the states. Raising the drinking age to 21 comes to mind. That's extortion, plain and clear, and the responsible parties owe the country an apology and jail time, imo.
If a state wants to impose a system in that state, fine. If each of the 50 states wants its own, fine. In fact, that will set up a system of benchmarking that will ensure constant comparisons, benchmarking, innovation, and improvement - unlike a federal monopoly.
uke:
