for healthcare reform
N A T I O N A L H E A L T H I n i t i a t i v e
To release the PARADIGM PARALYSIS dominating our nation’s healthcare
INTRODUCTION
” Never doubt that
a few committed people can change the world.
In the end, it’s the only thing that ever has. “
Margaret Mead ( 1901 – 1978 )
” It’s better for everybody
when it gets better for everybody. “
Eleanor Roosevelt ( 1884 – 1962 )
” To create long-lasting social change,
organizations and the programs they create
must in one way or another
become embedded in the local community. “
Eric Nee ( 1954 – )
MODERN HEALTHCARE BEGAN . . .
Before 1850, healthcare usually occurred within the home of each person’s Family. Historically, the healthcare exceptions only occurred with hunting/gathering, war-time, or poverty as in homelessness. After 1850, healthcare slowly began to progressively move out of a person’s home and into another institutional location. During the next 170 years, healthcare eventually became the responsibility of persons who have only a limited connectedness with the person. Also, the decreased connectedness includes little, if any, awareness about a person’s Family, their extended Family, their Family traditions, or their micro-social networks.
The use of infection control and anesthesia for surgery began this process of change for a person’s healthcare from the home of a person’s Family to a healthcare institution. The history of this transition has also interacted with the social, economic, and scientific trends underlying our nation’s heritage. The increasingly scientific and economic basis for healthcare is now associated with institutional governance problems within our nation’s healthcare industry, especially as dominated by its economic needs. For a community, each person’s Family has lost its traditional means, viz health care, for sustaining the caring relationships with their extended Family.
- COMMENT In effect, the historical evolution of healthcare mirrors our nation’s evolving cultural and ecologic traditions that have jeopardized the resilience of each community’s social cohesion, Family by Family. Along with many contributing social changes, a decrease in the prevalence of trust, cooperation, and reciprocity has occurred during the last 170 years among the social networks of most communities. The decline in each community’s social cohesion is likely the best explanation for the decline in the capability of many communities to maintain their Survival Commons (aka, enhanced safety net) for the benefit of each community’s resident persons.
a NEW STRATEGY
To sustain each community’s Survival Commons, our nation’s healthcare industry will require a new strategy to solve its current level of institutional paralysis. This new strategy should offer nationally sanctioned assistance for each community of nearly 400,000 citizens to initiate a collective action plan for strengthening the capability of its own expression of social cohesion. Locally managed and funded, a community-based new strategy would begin with a special focus on the equitable availability and ecologic accessibility of the Primary Healthcare that is offered to each citizen, community by community. The comprehensive renewal of Primary Healthcare will be necessary for resolving the cost and quality problems of our nation’s healthcare.
- COMMENT The content of the Blog is based on a set of uniquely-defined concepts. Where important to reduce cognitive dissonance, these terms can be identified by the use of italics. These generally represent the terms connected with the inter-connected definitions for caring relationship, cluster, collective action, community, disruptive processes, Family, HEALTH, person, social capital, social cohesion, social dilemma, and Survival Commons.
- COMMENT A set of definitions for these new concepts can be found by clicking on the RATIONALE Sub-Page. It can be located on the list of the Blog’s Pages and Sub-Pages located on the grey panel to your right. You will need to scroll to the top of this Page to find it. You will be transferred immediately to that Sub-Page by clicking on it.
REFORM THROUGH INSTITUTIONAL CHANGE – Stage One ( 1 year ) 2021-2022
” We must, indeed, all hang together,
or most assuredly we shall all hang separately. “
Benjamin Franklin ( 1705 – 1790 )
MUTUAL BENEFICENCE
One can only imagine the profound level of resolve among the members of the Second Continental Congress that convened in 1776, as they were about to sign our nation’s Declaration of Independence. The meaning of the words above, spoken then by Benjamin Franklin, eventually became real as borne out subsequently by history. At a much different point in time nearly 250 years later, I now propose that the sentiment of Benjamin Franklin should represent the level of precision that will be necessary for the actual reform of our nation’s healthcare industry. We will need a higher level of broadly expressed trust, cooperation, and reciprocity within every community to resolve the current problems within our nation’s healthcare and mitigate the prospect of “hanging separately.”
- COMMENT A new semi-autonomous institution, NATIONAL HEALTH, will be required. The new institution would be Chartered by an act of Congress and instituted thereafter within 6 months during 2021. The Charter would prohibit any involvement in the disbursement of financial capital or any other forms of financial support for healthcare by the new institution. Its governance would be structured to acknowledge the needs of and collaboration by each individual State and its communities. Finally, it would be Federally financed with a fixed budget of $1.50 per citizen per year, annually adjusted for inflation. A proposal for the initial Governance of NATIONAL HEALTH can be found under the GOALs Page by a Sub-Page with the title of initial GOVERNANCE.
- COMMENT The Congressional Charter for NATIONAL HEALTH would include a 10 year, sunset provision if its GOALs were not met. At the end of 10 years, three specific GOALs would require affirmative certification by the President to Congress. They are: 1) decrease health spending as a portion of our national economy from nearly 18% to 13.0% or less of our nation’s annual Gross Domestic Product (GDP), 2) decrease our nation’s annual maternal mortality incidence by 70%, and 3) achieve full participation by all States as approved by their respective State legislature.
GOVERNANCE
As implemented by its semi-autonomous Board of Trustees, NATIONAL HEALTH would implement three national projects to improve Primary Healthcare. The three national projects will be augmented by a new strategy to promote community by community collaboration for enhancing its locally-focused Survival Commons (viz, augmented safety net) beginning with the equitable availability of its Primary Healthcare.
The NATIONAL HEALTH Initiative Page and its Sub-Pages describe its anticipated structure and function. There is a preliminary initial STRATEGIC PLAN Sub-Page under the GOALS Page for the initial affairs of NATIONAL HEALTH.
- COMMENT For the purposes of NATIONAL HEALTH, each community is intended to represent on average about 400,000 citizens. Conversely, for sparsely populated areas, a community might comprise only 100,000 citizens. Ultimately, NATIONAL HEALTH would be most broadly identifiable by its nearly 800 Community HEALTH Forums. Establishing and assisting with the tasks of each community’s Forum can be understood as described in the Community HEALTH Forum Page and its Sub-Pages.
- COMMENT To steadily improve the national fabric of Primary Healthcare that is offered locally, three national projects will be required. First, NATIONAL HEALTH will establish a Basic Health Benefits Plan to define the minimum benefits qualified for their reimbursement by all the current economic sources that support comprehensive healthcare. For the second national project, a HEALTH SECURITY certification process will be established to identify the Primary Healthcare clinics that would qualify for augmented reimbursement. Finally, NATIONAL HEALTH will coordinate with all the various stakeholders to establish a Plan to implement a career-long, professional growth process for the physician members of every HEALTH SECURITY certified, Primary Healthcare clinic. The professional growth process will include medical school, under-graduate as well as post-graduate medical education and any maintenance-of-certification processes maintained by the Board of Medical Specialties.
GETTING STARTED
Given Congressional authorization and Presidential approval, the initial Meeting of the NATIONAL HEALTH Board of Trustees could occur within 6 months of the Congressional Charter’s approval by Congress and the President. During 2021, the initial Meeting would be held in St. Louis, Missouri. It is the largest city that is nationally accessible and located closest to the geographic population center of the United States.
STABILIZE HEALTH SPENDING – Stage Two ( 4 years ) 2022-2026
GOALS
Among many conflicting issues, the ultimate problem of our nation’s healthcare is its cost as a portion of our national economy. In 1960, ‘health spending’ represented 5.0% of our national economy as measured by its GDP. For 2018, ‘health spending’ represented 17.8% of the GDP. During the intervening 58 years, ‘health spending’ as a portion of our national economy increased by 2.21% compounded annually. This increased ‘health spending’ as a portion of our national economy represents a growth rate without considering economic growth and inflation.
Using data from the Organization for Economic Co-operative Development (OECD) and its 35 member nations, we learn that the other 34 nations have ‘health spending’ that is less than 13% of their GDP in 2018. Using 13% for these nations as a GOAL for our nation and 17.8% for our GDP in 2018, the excess ‘health spending’ for our nation in 2018 would have represented $1.05 trillion. This excess was equivalent to the cost of waging 10 Iraqi/Afghanistan Wars simultaneously during 2005.
The slowly progressive, increase in ‘health spending’ has now compromised the ability of our nation’s Federal Government to support education and infrastructure development. It is known that spending on education has a return on investment (ROI) for economic growth of 3:1, 7:1 for early childhood education, and 4:1 for anticipatory disaster mitigation projects, such as flooding control. Most importantly, the increased contribution to our nation’s ‘health spending’ paid by the Federal treasury (Medicare and Medicaid) represented 58% of our nation’s Federal fiscal deficit for 2018 and 50-60% during the interval years prior to 2018. In effect, our nation’s Federal government is headed to bankruptcy principally from the burden of our nation’s annually increased ‘health spending.’
- COMMENT Initially, each community’s Community HEALTH Forum will evaluate the adequacy of its own equitably available, Primary Healthcare. The accountabilities for resolving the patterns of deficiency will be evaluated and a long-term plan for their resolution will be approved by each community’s Community HEALTH Forum. Nearly 800 communities would be involved, each defined for a citizen population of approximately 400,000 citizens. NATIONAL HEALTH would offer consultation and training support for each community’s Forum. The ongoing support of each Forum would come from within their own community’s principal stakeholders.
COMMUNITY – CENTERED
The long-term function of each Community HEALTH Forum would focus on promoting an adequate level of social capital within their own community. Ultimately, this would involve a responsibility to define the community’s Survival Commons and its responsiveness to the needs of its citizens for achieving Stable HEALTH regardless of the disruptive processes ultimately shaping each person’s HEALTH.
Six years after the initial Meeting of the Board of Trustees, the portion of the GDP allocated to ‘health spending’ will have stopped increasing faster than economic growth for 1 or more years. This may be solved initially by an increased rate of economic growth as promoted by a slowing of annually increased health spending, especially for reducing our nation’s annual fiscal deficit.
Stable HEALTH for Each Citizen -Stage Three ( 5 years ) 2026-2031
SOCIAL CAPITAL
The institutional and health spending issues should be considered as preliminary phases for solving the quality problems of our nation’s HEALTH. Many of these have root causes that originate from within the “…mindless menace of violence…” that afflicts most communities. The processes for improving the level of social capital within each community will be unique to their own local ecologic and cultural traditions. Defining these locally occurring root-causes will be required to define the strategies for reducing the prevalence of each community’s violence. I propose that our nation’s annual incidence of maternal mortality should be the most important attribute of our long-term progress for the improvement of child abuse, childhood obesity, adolescent suicide/homicide, substance addiction, mass shootings, homelessness, mid-life depression/disability, and annually declining longevity at birth since 2014.
The OECD (Organization for Economic Cooperation and Development) regularly reports maternal mortality ratio (MMR) trends from among its 35 member nations. From 1990 thru 2014, the average maternal mortality incidence of the OECD nations decreased from 32 to 14 deaths per 100,000 live births. For the United States, our maternal mortality ratio during the last 30 years has increased. Our nation’s MMR in 2014 was 23.8 maternal deaths per 100,000 live births.
In 2014, there were 3,985,924 USA live births. The analysis of this data indicates that 948 maternal deaths occurred in 2014. It is possible to assume that at least 770 of these women died in 2014 because they were living in the wrong nation before the onset of their pregnancy. If these women had been living within 1 of the 10 nations within the OECD with the lowest maternal mortality incidence, at least 770 of the 948 women who died in connection with a pregnancy in 2014 could still be alive. These 10 OECD nations have an average maternal mortality incidence that is 70% lower than the incidence for the United States.
- COMMENT The State by State improvement for its available and accessible Primary Healthcare and the improved level of social cohesion from their Community HEALTH Forum activities will eventually reduce our nation’s maternal mortality ratio by 70%. This improvement will require a generational “shoot the moon” level of commitment and precision. The renewed “moon shot” begins with the initial meeting of the Board of Trustees to officially incorporate NATIONAL HEALTH.
PERMANENT, DILIGENT HEALTHCARE REFORM
NATIONAL HEALTH
Our nation’s autonomy within the worldwide market-place arenas for its Resources, Knowledge, and Human Dignity will likely require a means to plan and promote a unified process for the distant future of healthcare reform. I am continually reminded that only 10% of the world’s population outside of the USA live in a nation with our nation’s Constitutionally-guaranteed First Amendment rights of speech, religion, press, assembly, and petition. Unfortunately, I suspect that the percentage of our citizens as a portion of the worldwide population is probably shrinking.
We should firmly recognize the pervasive level of cognitive dissonance that exists within the global marketplace arena for the Human Dignity obligations demonstrated by each of the world-wide nation-states.
- COMMENT: Our nation’s stability will become severely challenged as the world adapts to another 2 Billion extra human beings by 2050 and another 2 Billion by 2100. Given a 7.7 billion world-wide population in 2019, the future cost and quality problems of our nation’s healthcare must have a nationally promoted, locally managed, and broadly sanctioned new strategy. Global warming only complicates these issues. A new plan to resolve our nation’s HEALTH problems will be required.
- COMMENT: The new strategy should be equitably decentralized and steadily adjusted as its performance continues to evolve. We must pursue continued improvements in its quality and cost of our nation’s healthcare that will achieve a stable portion of our national economy allocated to health spending, ideally 11-12%. At that level, the funding needs for under-graduate and post-graduate medical education will need to be increasingly Federally funded by Congressional action that justly supports both our needs for Basic Healthcare as well as for Complex Healthcare. The current process for its funding is unstable, has no means to encourage Primary Physicians, and has no means to hold our medical education institutions accountable.
S U B – P A G E S
PREFACE I describe the circumstances in 2007 that prompted this Blog. Most of the Blog’s Pages and their Sub-Pages begin with a quotation. The PREFACE Sub-Page begins with a quotation from Gertrude Stein. In effect, she is saying: you will not think carefully about an idea, person, or event until you can clearly communicate about them with the written word.
Personally, I am still an advocate of the handwritten variety as documented by my eventual entry into word processing soon after reaching my 57th birthday in 1999. The process of producing a handwritten document for a “care plan” during an office visit had for many years helped me to improve the precision of defining the healthcare plan during each person’s health care appointment. This was especially necessary to coordinate the healthcare for any person who required multiple medications taken at least once a day.
CONTENTS There are eight main Pages for the Blog. I describe the intent of each main Page on this Sub-Page. Its INTRODUCTION describes a possible root-cause of root-causes for the current disarray afflicting the critically flawed character of our nation’s healthcare reform strategies.
RATIONALE I hope you are energized AND open to considering new realms of Knowledge for a better strategy to guide our Nation’s healthcare reform. I have encountered many new realms of Knowledge as I have attempted to arrive at an expanded understanding of HEALTH. The recognition that a state of Paradigm Paralysis has afflicted our nation’s healthcare has prompted the search for a new strategy to unleash its underlying quality and sophistication.
To achieve resolution of the Paradigm Paralysis renewal, any new strategy for healthcare reform will require a new basis for reducing the cognitive dissonance regarding the occurrence population HEALTH problems. This Sub-Page introduces twelve interconnected definitions as a basis for considering the alternative options available for implementing any new strategy.
revision LOG The introduction of new ideas to the Blog has occurred fitfully since the beginning of this Blog in 2008. In 2014, I began to document the pace and character of the evolving concepts underlying the NATIONAL HEALTH Initiative.
- COMMENT: The revision LOG is the only Sub-Page that you can use to be identified as a follower. That way, you will be notified about “what’s new” when I have made a substantial update.
This page has the following sub pages.
