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I am not a U.S native but very much interested in understanding this.

Let's say the U.S president has an idea that he thinks can improve, using government's money, the general welfare of the public.

What steps, and agencies, would it entail from the idea to the execution?

Let's say he wants to open up 200 bed hospital in every city greater than a certain population threshold. What will be the steps and agencies involved in evaluating and executing this?

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    As the US and UK will require two different answers, it would be a fairly long answer for both. As the scope of your question seems to heavily point to the US, I would narrow it down to just them, but that's at your own discretion. – Bradley Wilson Apr 23 '17 at 11:12
  • The UK part made the question too broad. I removed it. But feel free to post a second question which asks the same about the prime minister of the UK. – Philipp Apr 23 '17 at 12:00
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When the POTUS wants hospitals to be built, he or she could do so through an executive order, likely through the Department of Health and Human Services. There is just a slight problem: Building hospitals takes money, and it is unlikely that the DoHHS budget has enough non-earmarked funds which can be diverted to this project.

Whenever the US government needs money, they need to ask Congress and Senate to change the budget. So the government would propose a bill which earmarks funds for this project, either by diverting them from other government programs, by raising more taxes or by making more debt.

Now let's say the bill get a majority in both houses, but some local politicians don't want the US government to build a hospital in their city. Maybe they don't want to drive the local for-profit hospitals out of business. Maybe they oppose public health care for ideological reasons. What could they do?

They could check if there is anything about the budget bill or the executive order which violates the constitution in some way. Then they could try to get the US Supreme Court to shoot it down. If that doesn't work, even the federal government needs a building permit when they want to build something, so they could just refuse to give one. Or they could make local laws and regulations on the state- or county level which apply to hospitals and make it impossible or infeasible for the federal government to operate a hospital in their municipality.

  • Thank you @Philipp♦ for the answer. Is there any official documentation that I can consult as well? – user151193 Apr 25 '17 at 5:18
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What steps, and agencies, would it entail from the idea to the execution?

for small things (like allocating more money for a tunnel under construction), he can do that with the stroke of a pen;

for larger things (like obamacare), he would have to go through the congress for funds dedicated to that.

Let's say he wants to open up 200 bed hospital in every city greater than a certain population threshold. What will be the steps and agencies involved in evaluating and executing this?

Depending on the threshold and how much is involved but generally speaking, the fed isn't involved solely for something like that. they typically provide match funding / grants that coupled with local money will complete the whole project.

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