Yesterday I read the op-ed “In Defense of Britain’s Health System” by British doctors Ara Darzi and Tom Kibasi in the Washington Post. Near the end of the article they stated:
Standing in defense of Britain’s health service does not mean that we believe it is the right prescription for the United States. It is not for us to propose the solution for America, but we hope that correcting the record on some of the facts about our NHS will help Americans evaluate the real strengths and challenges of our system, instead of focusing on the misinformation spread by fear-mongers.
It got me thinking, what if the American healthcare reform was simply expanded Medicare coverage? Even though only people 65 or older qualify for Medicare, its already America’s largest health insurance program, covering over 40 million Americans (Number of Uninsured Americans = 47 million). This concept of expanding America’s current single-payer healthcare option is already outlined in the bill HR 676, which is withering away in Congress due to intense pressure from insurance corporations, pharmaceutical corporations, industry trade groups, and small-government conservatives. But what if Americans received a Medicare Constitution that outlined the rights, pledges, expectations, responsibilities, and values of a national healthcare system? To answer these hypothetical questions I decided to plagiarize the British NHS Constitution and replace NHS with Medicare and Parliament with Congress (as well as few other minor changes). Below is the result:
Medicare belongs to the people.
It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.
Medicare was founded on a common set of principles and values that bind together the communities and people it serves – patients and public – and the staff who work for it.
This Constitution establishes the principles and values of Medicare in the United States of America. It sets out rights to which patients, public and staff are entitled, and pledges which Medicare is committed to achieve, together with responsibilities which the public, patients and staff owe to one another to ensure that the Medicare operates fairly and effectively. All Medicare bodies and private and third sector providers supplying Medicare services will be required by law to take account of this Constitution in their decisions and actions.
The Constitution will be renewed every 10 years, with the involvement of the public, patients and staff. It will be accompanied by the Handbook to the Medicare Constitution, to be renewed at least every three years, setting out current guidance on the rights, pledges, duties and responsibilities established by the Constitution. These requirements for renewal will be made legally binding. They will guarantee that the principles and values which underpin Medicare are subject to regular review and recommitment; and that any government which seeks to alter the principles or values of Medicare, or the rights, pledges, duties and responsibilities set out in this Constitution, will have to engage in a full and transparent debate with the public, patients and staff.
1. Principles that guide Medicare
Seven key principles guide Medicare in all it does. They are underpinned by core Medicare values which have been derived from extensive discussions with staff, patients and the public. These values are set out at the end of this document.
1. Medicare provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.
2. Access to Medicare services is based on clinical need, not an individual’s ability to pay. Medicare services are free of charge, except in limited circumstances sanctioned by Congress.
3. Medicare aspires to the highest standards of excellence and professionalism – in the provision of high-quality care that is safe, effective and focused on patient experience; in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organizations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population.
4. Medicare services must reflect the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.
5. Medicare works across organizational boundaries and in partnership with other organizations in the interest of patients, local communities and the wider population. Medicare is an integrated system of organizations and services bound together by the principles and values now reflected in the Constitution. Medicare is committed to working jointly with local authorities and a wide range of other private, public and third sector organizations at national and local level to provide and deliver improvements in health and well-being.
6. Medicare is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that Medicare serves.
7. Medicare is accountable to the public, communities and patients that it serves. Medicare is a national service funded through national taxation, and it is the Government which sets the framework for Medicare and which is accountable to Congress for its operation. However, most decisions in Medicare, especially those about the treatment of individuals and the detailed organization of services, are rightly taken by state & local Medicare and by patients with their clinicians. The system of responsibility and accountability for taking decisions in Medicare should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of Medicare’s accountability for this purpose.
2a. Patients and the public – your rights and Medicare’s pledges to you
Everyone who uses Medicare should understand what legal rights they have. For this reason, important legal rights are summarized in this Constitution and explained in more detail in the Handbook to the Medicare Constitution, which also explains what you can do if you think you have not received what is rightfully yours. This summary does not alter the content of your legal rights.
The Constitution also contains pledges that Medicare is committed to achieve. Pledges go above and beyond legal rights. This means that pledges are not legally binding but represent a commitment by Medicare to provide high quality services.
Access to health services:
You have the right to receive Medicare services free of charge, apart from certain limited exceptions sanctioned by Congress.
You have the right to access Medicare services. You will not be refused access on unreasonable grounds.
You have the right to expect your local Medicare provider to assess the health requirements of the local community and to commission and put in place the services to meet those needs as considered necessary.
You have the right, in certain circumstances, to go to other states or countries for treatment which would be available to you through your local Medicare provider.
You have the right not to be unlawfully discriminated against in the provision of Medicare services including on grounds of gender, race, religion or belief, sexual orientation, disability (including learning disability or mental illness) or age.
Medicare also commits:
- to provide convenient, easy access to services within the waiting times set out in the Handbook to the Medicare Constitution (pledge);
- to make decisions in a clear and transparent way, so that patients and the public can understand how services are planned and delivered (pledge); and
- to make the transition as smooth as possible when you are referred between services, and to include you in relevant discussions (pledge).
Quality of care and environment:
You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organization that meets required levels of safety and quality.
You have the right to expect Medicare organizations to monitor, and make efforts to improve, the quality of healthcare they commission or provide.
Medicare also commits:
- to ensure that services are provided in a clean and safe environment that is fit for purpose, based on national best practice (pledge); and
- to continuous improvement in the quality of services you receive, identifying and sharing best practice in quality of care and treatments (pledge).
Nationally approved treatments, drugs and programs:
You have the right to drugs and treatments that have been recommended by FDA for use in Medicare, if your doctor says they are clinically appropriate for you.
You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If Medicare decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you.
You have the right to receive the vaccinations that the CDC recommends that you should receive under a Medicare-provided national immunization program.
Medicare also commits:
- to provide screening programs as recommended by the Department of Health and Human Services (pledge).
Respect, consent and confidentiality:
You have the right to be treated with dignity and respect, in accordance with your human rights.
You have the right to accept or refuse treatment that is offered to you, and not to be given any physical examination or treatment unless you have given valid consent. If you do not have the capacity to do so, consent must be obtained from a person legally able to act on your behalf, or the treatment must be in your best interests.
2b. Patients and the public – your responsibilities
Medicare belongs to all of us. There are things that we can all do for ourselves and for one another to help it work effectively, and to ensure resources are used responsibly:
You should recognize that you can make a significant contribution to your own, and your family’s, good health and well-being, and take some personal responsibility for it.
You should register with a General Practitioner, who will become your main point of access to Medicare.
You should treat Medicare staff and other patients with respect and recognize that causing a nuisance or disturbance in clinics and hospitals could result in prosecution.
You should provide accurate information about your health, condition and status.
You should keep appointments, or cancel within reasonable time. Receiving treatment within the maximum waiting times may be compromised unless you do.
You should follow the course of treatment which you have agreed, and talk to your clinician if you find this difficult.
You should participate in important public health programs such as vaccination.
You should ensure that those closest to you are aware of your wishes about organ donation.
You should give feedback – both positive and negative – about the treatment and care you have received, including any adverse reactions you may have had.
3a. Staff – your rights and Medicare pledges to you
It is the commitment, professionalism and dedication of staff working for the benefit of the people Medicare serves which really make the difference. High quality care requires high quality workplaces, with commissioners and providers aiming to be employers of choice.
All staff should have rewarding and worthwhile jobs, with the freedom and confidence to act in the interest of patients. To do this, they need to be trusted and actively listened to. They must be treated with respect at work, have the tools, training and support to deliver care, and opportunities to develop and progress.
The Constitution applies to all staff, doing clinical or non-clinical Medicare work, and their employers. It covers staff wherever they are working, whether in public, private or third sector organizations.
Staff have extensive legal rights, embodied in general employment and discrimination law. These are summarized in the Handbook to the Medicare Constitution. In addition, individual contracts of employment contain terms and conditions giving staff further rights.
The rights are there to help ensure that staff:
- have a good working environment with flexible working opportunities, consistent with the needs of patients and with the way that people live their lives;
- have a fair pay and contract framework;
- can be involved and represented in the workplace;
- have healthy and safe working conditions and an environment free from harassment, bullying or violence;
- are treated fairly, equally and free from discrimination; and
- can raise an internal grievance and if necessary seek redress, where it is felt that a right has not been upheld.
In addition to these legal rights, there are a number of pledges, which Medicare is committed to achieve. Pledges go above and beyond your legal rights. This means that they are not legally binding but represent a commitment by Medicare to provide high-quality working environments for staff.
- to provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers and communities (pledge);
- to provide all staff with personal development, access to appropriate training for their jobs and line management support to succeed (pledge);
- to provide support and opportunities for staff to maintain their health, well-being and safety (pledge); and
- to engage staff in decisions that affect them and the services they provide, individually, through representative organizations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families (pledge).
3b. Staff – your responsibilities
All staff have responsibilities to the public, their patients and colleagues.
Important legal duties are summarized below.
You have a duty to accept professional accountability and maintain the standards of professional practice as set by the appropriate regulatory body applicable to your profession or role.
You have a duty to take reasonable care of health and safety at work for you, your team and others, and to cooperate with employers to ensure compliance with health and safety requirements.
You have a duty to act in accordance with the express and implied terms of your contract of employment.
You have a duty not to discriminate against patients or staff and to adhere to equal opportunities and equality and human rights legislation.
You have a duty to protect the confidentiality of personal information that you hold unless to do so would put anyone at risk of significant harm.
You have a duty to be honest and truthful in applying for a job and in carrying out that job.
The Constitution also includes expectations that reflect how staff should play their part in ensuring the success of Medicare and delivering high-quality care.
You should aim:
- to maintain the highest standards of care and service, taking responsibility not only for the care you personally provide, but also for your wider contribution to the aims of your team and Medicare as a whole;
- to take up training and development opportunities provided over and above those legally required of your post;
- to play your part in sustainably improving services by working in partnership with patients, the public and communities;
- to be open with patients, their families, carers or representatives, including if anything goes wrong; welcoming and listening to feedback and addressing concerns promptly and in a spirit of co-operation. You should contribute to a climate where the truth can be heard and the reporting of, and learning from, errors is encouraged; and
- to view the services you provide from the standpoint of a patient, and involve patients, their families and carers in the services you provide, working with them, their communities and other organizations, and making it clear who is responsible for their care.
Patients, public and staff have helped develop this expression of values that inspire passion in Medicare and should guide it in the 21st century. Individual organizations will develop and refresh their own values, tailored to their local needs. Medicare values provide common ground for cooperation to achieve shared aspirations.
Respect and dignity. We value each person as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits. We take what others have to say seriously. We are honest about our point of view and what we can and cannot do.
Commitment to quality of care. We earn the trust placed in us by insisting on quality and striving to get the basics right every time: safety, confidentiality, professional and managerial integrity, accountability, dependable service and good communication. We welcome feedback, learn from our mistakes and build on our successes.
Compassion. We respond with humanity and kindness to each person’s pain, distress, anxiety or need. We search for the things we can do, however small, to give comfort and relieve suffering. We find time for those we serve and work alongside. We do not wait to be asked, because we care.
Improving lives. We strive to improve health and well-being and people’s experiences of Medicare. We value excellence and professionalism wherever we find it – in the everyday things that make people’s lives better as much as in clinical practice, service improvements and innovation.
Working together for patients. We put patients first in everything we do, by reaching out to staff, patients, carers, families, communities, and professionals outside Medicare. We put the needs of patients and communities before organizational boundaries.
Everyone counts. We use our resources for the benefit of the whole community, and make sure nobody is excluded or left behind. We accept that some people need more help, that difficult decisions have to be taken – and that when we waste resources we waste others’ opportunities. We recognize that we all have a part to play in making ourselves and our communities healthier.
Alas, I don’t think Americans will receive such a utopic result when it comes to healthcare reform. As I stated before, there is too much money to be made off of pain & suffering for the American system to radically change to a system like the one parodied above. But I do have hope that one day people will wake up and realize that we are all in this together.