I found this article absolutely fascinating. I’ve blogged about the two acts of Congress that are referenced throughout this article [H.R. 259 – An act to retrocede the county of Alexandria, in the District of Columbia, to the State of Virginia & An Act for establishing the Temporary and Permanent seat of the Government of the United States], but until today I had not thoroughly read a legal opinion on the topic of Virginia’s retrocession of Alexandria County (now present-day Arlington County). My original contention was that the Act of 1846 was illegal because the text of the Act specified that retrocession was possible only with the approval of both the city *and* the county of Alexandria, and only the city voted in favor retrocession. The argument presented in this article below speaks to the larger issue of how the “permanent” seat of government was created out of a legal covenant that involved four parties: the Federal Government, Virginia, Maryland, and the original 19 property owners of the District. A very compelling case is made that through the passage of the Act of 1846 the original covenant was unconstitutionally broken. 99 years later, I thoroughly agree with the logic outlined in the article below and would like to have the District of Columbia return to its original size. While I don’t see it happening any time soon, history shows that change is constant.

The Washington Herald, January 18th, 1910
DOES VIRGINIA OWN ALEXANDRIA COUNTY?
Hon. Harris Taylor, in Elaborate Opinion, Holds the Retrocession Was Clearly Illegal and Unconstitutional.
Was the act of July 9, 1846, under which the County of Alexandria, then in the District of Columbia, was re-ceded to the State of Virginia unconstitutional?
Hon. Hannis Taylor, former Minister to Spain, and a constitutional lawyer of distinction, has prepared an elaborae opinon on this subject, which was presented to the Senate yesterday, in which he holds that the retrocession was clearly illegal and unconstitutional.
“If retrocession to Virginia is to stand,” he says, “then the land underlying the Capitol, the White House, and the Treasury belongs either to Maryland or the local proprietors whom it was granted. The nation can only be protected against that result by a judgement of the Supreme Court of the United States declaring the act of retrocession of 1846 to be null and void.”
Complete Answer Found.
What is the remedy?
“The complete answer,” he says, “is to be found in the opinion of the Supreme Court in the case of The United States vs. Texas (143 U.S.,621-649), in which it was held that the Supreme Court can, under the Constitution, take cognizance of an original suit brought by the United States against a State to determine the boundary between one of the Territories and such State; that the Supreme Court has jurisdiction to determine a disputed question of boundary between the United States and a State; that a suit in equity begun in the Supreme Court is appropriate for determining a boundary between the United States and one of the States.”
He quotes the opinion rendered in this case, and says it solves every problem that can possibly arise in an original suit between the United States and Virginia as to the boundaries of the District of Columbia.
Act of 1846.
His opinion as to the unconstitutionality of the retrocession is based upon the contention that the act of 1846 broke a quadrilateral contract entered into on the one hand by the United States and on the other by Virginia, Maryland, and the nineteen local property-owners in Washington.
The United States, through the act of Congress of July 10, 1790, passed under the constitutional mandate, agreed that “the District so defined, limited, and located, shall be deemed the District accepted by this act, for the permanent seat of the government of the United States.”
Each of the three grantors, in consideration of that stipulation, made for the benefit of each, through which alone title to the whole could be made perfect, entered into the quadrilateral contract in question.
“It is elementary in the law of contracts,” he says, “that when two or more instruments are recorded at the same time or at different times which relate to the same subject matter, and one refers to the other, either tacitly or expressly, they will be taken together and construed as one instrument.
Maryland’s Right.
“Maryland,” he says, “has a perfect right to claim of the United States, by reason of the recision of the original quadrilateral agreement, the return of every foot of land ceded by her and now embraced within the present limits of the District.
“That right Maryland can enforce in an original suit against the United States in the Supreme Court under the authority laid down in the case of the United States vs. Texas.
“That great case,” he says, “refuted most emphatically the contention made by Senator Hoar in the Senate on April 11, 1902, that retrocession was a political and not a judicial question, and was settled by the political authorities, alone competent to decide it.
“The Supreme Court in the case in question decided that ‘it cannot with propriety be said that a question of boundary between a Territory of the United States and one of the States of the Union is of a political nature and non susceptible of judicial determination by a court having jurisdiction of such a controversy.
Constitutional Mandate.
“The constitutional mandate that requires the President to ‘take care that the laws be faithfully executed’ compels him to ascertain and determine the limits of territory over which they are to be enforced.”
And in conclusion he says:
In determining all question all questions of boundary, whether foreign or domestic, the initiative in this country is vested in the Executive acting alone. While he may advise with Congress as to the steps he may take in ascertaining boundaries, while executing the laws within the same, the President cannot surrender his exclusive power to ascertain what they are.
As a practical illustration, if in this matter the President believes that Virginia is in lawful possession of that portion of the District described in the act of 1846, it is his constitutional duty to “take care that the laws be faithfully executed” in that area, regardless of any contrary opinion the legislative department of the government might entertain on the subject. He could hold no other view without abdicating the independence of the executive power in the execution of the laws. It is, however, in my humble judgment, a case in which there should be friendly consultation between the executive and legislative departments, because in the event of a recovery in the Supreme Court Congress would no doubt be called upon to pass such a bill of indemnity as would relieve Virginia of any accountability for revenues derived from the area in question during her de facto occupation.
Goes in the Record.
Senator Carter, in presenting the elaborate brief written at his request by Mr. Taylor, asked and was granted unanimous consent to have it printed in the Record, and also as a Senate document. He said:
The subject is of absorbing interest to the people of the District and will surely challenge the attention of the country with constantly increasing force as the growth of the Federal city and the expanding needs of the government demonstrate more fully the wisdom of President Washington and his co-laborers in fixing the District lines as originally marked.
To the United States government the subject is of
Continued on Page 3, Column 4
DOES VIRGINIA OWN ALEXANDRIA COUNTY
Continued from Page One.
grave concern, for it involves in a technical sense title to the ground upon which this Capitol, the White House, and many other important public buildings stand. If the recession to Virginia stands in law it would seem possible that the Federal government retains jurisdiction over the portion north of the Potomac in derogation of the rights and at the sufferance of the State of Maryland.
Fever-breeding Marsh.
When artistic taste and solicitude for sanitary conditions combined to inspire the movement to reclaim the Potomac Flats, the progress of the work soon revealed the fact that proper treatment of the narrow river and adjacent marshes would always be limited and unsatisfactory while confined to the northern bank alone. A fever-breeding marsh within 7,000 or 8,000 feet of the White House cannot be regarded with indifference, nor can any one fail to observe that the improvement on the north sets forth the unsightliness of the south bank of the river in bold relief. In short, each year more amply justifies the wisdom of Washington and his commission in embracing both sides of the river within the limits of the Federal District.
The Capitol, the White House, and all the public buildings were located near the center in the beginning, but the act of retrocession moved the southern line of the District to within a short distance of the White House grounds. This was not intended by Washington, under whose masterful direction the constitutional design regarding a seat for the Federal government was executed.
Defeat of Intention.
“The act receding two-fifths of the District to Virginia so obviously defeats the intention of the framers of the Constitution in this behalf and so ruthlessly disregards the rights of other parties that I have for years regarded it as null and void on general principles; not withstanding the interesting and important nature of the question, I have not found time to investigate the law and the historical facts bearing upon it. Last year, however, I had the good fortune to mention the matter to Mr. Harris Taylor, known to the bar of the country as one of our leading constitutional lawyers, and the gentleman volunteered to examine the question and to write me his view upon it.
Mr. Taylor’s letter sets forth the constitutional provision in question and all legislation, State and national, in relation to the subject, together with a review of all executive action and contract obligations in pursuance thereof. In fact, the letter is a brief of such rare clearness and ability that I believe it should be made permanently available for reference, and so believing, I renew my request and ask that when printed the commincation be referred to the Committee on the District of Columbia for consideration.
An Exhaustive Opinion.
Mr. Taylor’s opinion, buttressed by historical references and legal citations, is exhaustive and comprehensive. He says, in beginning:
The contemporaneous evidence puts the fact beyond all question that the final definition of a district ten miles square as the seat of our Federal government was in a special sense the personal work of President Washington, whose task involved the acquisition of the title to the tract from three sources- the State of Virginia, the State of Maryland, and the nineteen local proprietors who owned that part at the heart of the present city which underlies the Capitol, the White House, and the Treasury. Washington’s task was to induce the three parties who held the title to cede to the Federal government, without any direct pecuniary consideration, the entire area under a quadrilateral contract in which that government was the grantee and beneficiary, and Virginia, Maryland, and nineteen local proprietors the grantors. The real consideration moving to such grantors was the incidental benefits to accrue to them from their joint cession, which, in the language of the act of July 16, 1790, “is hereby accepted for the permanent seat of the government of The United States.” That covenant represented the only consideration moving directly from the Federal government, while the three grantors were bound to each other by the mutual considerations moving from the one to the other under interdependent grants.
Maryland, the last to grant, expressed the idea of mutual benefits to be derived from a common enterprise when her legislature declared that “it appears to this general assembly highly just and expedient that all the lands within the said city should contribute, in due proportion, in the mean which have already greatly enhanced the value of the whole.” Under that quadrilateral contract, supported by the foregoing considerations, the Federal government entered into possession with a perfect title, after the final cession made by Maryland December 19, 1791.
Government in Control.
No one, perhaps, will deny that after the title to the entire area had thus passed from the three grantors into the corporate person of the nation neither the State of Virginia nor the State of Maryland could have, either in law or in equity, any claim to the common heritage superior to that of any other State. Under such considerations the Federal government remained in peaceful possession of the entire area ten miles square, and governed the same under the Constitution for a period of fifty-five years. During that time the original boundaries as designed by Washington were marked by massive stone monuments, while still abide unimpaired.
By the act of retrocession of July 9, 1846, the District was dismembered by a conveyance to Virginia of nearly one-half of the entire area for no pecuniary or property consideration whatever. What was the real motive of the retrocession it is at this time difficult to ascertain.
From a legal standpoint, the fact that the portion reconveyed to Virginia had originally been contributed by her is of no significance whatever. Therefore, before argument begins, the mind wonders upon what constitutional principle such retrocession could have been made. Two distinct parts of the Constitution are involved. First, that part of section 8, Article 1, which provides that Congress shall have power “to exercise exclusive legislation in all cases whatever, over such District (not exceeding ten miles square) as may, by cession of particular States and the acceptance of Congress, become the seat of government of the United States;” second, that part of section 10, article 1, which provides that “no State shall pass any bill of attainder, ex post facto law or law impairing the obligation of contracts.”
During the memorable Senate debate led by Senator Haywood, of North Carolina, who, as chairmen of the District Committee, bitterly assailed the constitutionality of the act of retrocession, the meaning and effect of section 8, Article 1, was fully explored.
I cannot doubt the soundness of the conclusion then reached by many leading statesmen of that day to the effect that, considered in reference to that part of the Constitution alone, the act of retrocession is null and void. What I cannot understand is the fact that any debate, however hastily conducted, the deeper and more obvious argument based on the contract clause of the Constitution (Article 1, section 10), should have been entirely overlooked. And yet the record shows that such was the fact.
It never occurred to any one in 1846, or since that time, to look to the sources of the title in the quadrilateral contract upon which the ownership of the area ten miles square really depends. What is said herein as to that branch of the subject is my personal contribution to the controversy.
Acquirement of Site.
He goes into history to show how the site of the National Capital was discussed and finally acquired, and says:
After prolonged discussion the act of July 16, 1790, was passed, and the site of the District finally located, partly in Prince George and Montgomery counties, in the State of Maryland, and partly in Fairfax County, in the State of Virginia, by proclamation of President George Washington, March 30, 1971, within the following bounds:
“Beginning at Jones Point, being the upper cape of Hunting Creek, in Virginia, and at an angle in the outset of 45 degrees west of the north, and running in a direct line ten miles for the first line; then beginning again at the same Jones Point and running another direct line at a right angle with the ffirst across the Potomac ten miles.”
From the diagram it appears that the “Portion derived from and receded to Virginia” constitutes nearly one-half of the territory of the District as originally defined in the proclamation of March 30, 1791. If the act of July 9, 1846 (9 Stats. 35), entitled “An act to retrocede the County of Alexandria, in the District of Columbia, to the State of Virginia,” is unconstitutional and void, the laws of the United States should now be executed by the President thourghout the “Portion derived from and receded to Virginia.”
Continuing, he says:
After the power to elect the seat of government had been once exercised by Congress, after the cession had been made for that purpose by “particular States,” after the area so ceded had been accepted by Congress under the act of July 16, 1790, declaring “the same is hereby accepted for the permanent seat of government of the United States,” the power of Congress over the subject matter was exhausted. Or, if it was not exhausted, could not again be exercised, because no power remained to transfer the District, as originally created and accepted, of any portion of it to any State. In other words, after a district of ten miles square had once been established and accepted as a permanent seat of government, Congress possessed no power to acquire another territory for another seat of government, without violating the constitutional limitation which confined it to the ten miles square. The Congress, an agent of limited authority, was expressly authorized to receive cessions from States of a limited amount of territory to be held as a permanent seat of government; but it was not authorized, expressly or implicitly, to give any part of such cessions away to any one. Such was the constitutional difficulty which the Hon. R. M. T. Hunter attempted to overcome when the bill in question was up for debate in the House of Representatives May 8, 1846.
Section 8 of Article 1 of the Constitution when taken as a whole, provides that “the Congress shall have power * * * to exercise exclusive legislation in all cases whatsoever over such District (not exceeding ten miles square) as may, by cession of particular States and the acceptance of Congress become the seat of the government of the United States; and to exercise like authority over all places purchased by the consent of the legislature of the State in which the same shall be for the erection of forts, magazines, arsenals, dockyards, and other needful things.” The delegation of power thus made Congress to acquire a seat of government for the United States, through formal acceptance of cessions to the be made by particular States is a distinct subject matter, entirely separate and apart from the succeeding delegation of power to govern “all places purchased by the consent of the legislature of the State in which the same shall be.” Did the grant of an express power formally to accept cessions from particular States, which were to constitute and “become the seat of government of the United States,” carry with it, as a necessary implication, the right to use the means necessary for the execution of the power? In other words, did the implied power to use such necessary means flow from the express to accomplish the end? In construing that clause which provides that Congress shall have power “to make all laws which shall be necessary and proper for carrying into execution the foregoing powers and all other powers vested by the Constitution in the government of the United States, or in any department or officer thereof,” it was held at an early day that the clause in question “confers on Congress the choice of means and does not confine it to what is indispensably necessary.”
Constitutional Mandate.
The express mandate was given by the Constitution to Congress to acquire a seat of government by cessions from particular States, and in no other manner. Congress was powerless to force any State to make a cession; it could not go beyond the limits of the States. It could only persuade; it could not command. Congress did not offer to the ceding States any money consideration whatever for their cessions. The means, and the only means, Congress saw fit to employ to accomplish a vitally important end was the promise, made in the of July 16th, 1790, that the seat of government to be located on the cessions should be “permanent.”
The act expressly declared that “the district so defined, limited, and located shall be deemed the district accepted by this act for the permanent seat of government of the United States.” When Mr. Madison moved in the House of Representatives to strike out the word “permanent” from the act he was voted down, and thus we have a legislative interpretation, practically contemporaneous, to the effect that the Constitution intended to confer upon Congress the power make the seat of government permanent. Contemporary interpretation of the Constitution, practiced and acquiesced in for years, conclusively fixes its construction.
Some years go, when a movement was on foot to remove the Capital to the Valley of the Mississippi, the effect of the action of Congress under section 8, Article 1, was fully discussed. I am informed that it was then universally admitted that by the selection of the present seat of government the power of Congress, under the section in question, had been exhausted.
Virginia made her grant, which was the first grant, December 3 1789. The nineteen local proprietors perfected their grants on or about the 29th of June, 1791. Maryland did not make grant until December 19, 1791. In that grant, embodied in a very elaborate act of thirteen sections, Maryland put the fact beyond all question that the prior grants made by Virginia and the nineteen proprietors were conditions precedent to her grant.
Quotes from Opinions.
He quotes from many opinions rendered by the Supreme Court of the United States to show that a grant is a contract, and this quadrilateral contract entered into by the United States on the one hand and Virginia, Maryland, and the nineteen local proprietors on the other, was binding in its operation and effect, and could not be modified without abrogating the contract as a whole.
Related Legislation Entries:
- Full Text of Ballot Initiative 71
- S.1 - A Bill to Regulate the Elective Franchise in the District of Columbia - 12/04/1865
- Map of the Ratification of the 23rd Amendment to the United States Constitution
- President Andrew Johnson’s Veto Message to Congress Concerning A Bill to Regulate the Elective Franchise in the District of Columbia - January 5, 1867
- Enrolled Text of the Legalization of Marijuana for Medical Treatment Initiative Amendment Act of 2010
- Act of Cession from the State of Virginia - December 3, 1789
- Debate in the U.S. House of Representatives Concerning An Act to Retrocede the County of Alexandria, in the District of Columbia, to the State of Virginia, Friday, May 8, 1846
- My Testimony Given Before The District Council Concerning The Legalization of Marijuana for Medical Treatment Initiative Amendment Act of 2010
- Suggested Revisions to the "Legalization of Marijuana for Medical Treatment Initiative Amendment Act of 2010" by the Washington, DC Chapter of Americans For Safe Access
- Draft Text of the Legalization of Marijuana for Medical Treatment Initiative Amendment Act of 2010
- VOTE PLEA TO CONGRESS - Americanize 400,000, Urges D.C. Joint Citizens' Committee - The Washington Post, February 13, 1918
- ALEXANDRIA AND THE DISTRICT OF COLUMBIA - The Alexandria Gazette, June 9, 1909
- A Bill To Extend The Limits of the District of Columbia - The Alexandria Gazette, June 1, 1909
- Does Virginia Own Alexandria County? - The Washington Herald, January 18, 1910
- The Medicare Constitution - American Healthcare Reform Parodied from the UK's NHS Constitution
- An Act for establishing the Temporary and Permanent seat of the Government of the United States
- Text of H.R. 259 - An act to retrocede the county of Alexandria, in the District of Columbia, to the State of Virginia
- Text of the District of Columbia Organic Act of 1871
- Text of the District of Columbia Organic Act of 1801
The Medicare Constitution – American Healthcare Reform Parodied from the UK’s NHS Constitution
|| 8/18/2009 || 1:01 pm || + Render A Comment || ||
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:
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:
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:
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:
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:
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.
Medicare commits:
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:
Medicare values
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.
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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.