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 of 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 Meade ( 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 1860, healthcare most prominently occurred within the home of each person’s Family. Historically, exceptions for a person only occurred with hunting/gathering, war-time, or poverty as in homelessness. Beginning at @1860, healthcare began to increasingly move out of a person’s home and into another institutional location. During the subsequent 150 years, each person’s healthcare became the responsibility of persons who usually had a limited, if any, prior connection with each person, their Family, their Extended Family, or their Family Traditions.
The use of infection control and anesthesia for surgery began this process of change for a person’s healthcare from a person’s Family home to a healthcare “facility.” The history of this transition has also interacted with the social, economic and scientific trends underlying our nation’s heritage. The increasingly scientific and basis for healthcare is now associated with institutional governance problems within our nation’s healthcare industry, especially its economic demands. And, for a community, each citizen’s Family has lost one of its traditional means, viz health care, for sustaining their relationships with an Extended Family as the basis for renewing their Family Traditions.
- COMMENT In effect, the historical evolution of contemporary healthcare has now 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 in the last 150 years among the citizen networks of most communities. This change has substantially worsened, especially since 1960. The decline in each community’s Social Capital is likely the best explanation for the decline in the capability of many communities to maintain the resilience of their Survival Commons for the benefit of each citizen.
a NEW STRATEGY
To augment 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 will offer a means to assist each community of approximately 400,000 citizens initiate a collective action process to strengthen its own Social Capital asset over a period of 10 years. To initiate this plan, the new strategy would begin with a special focus on the equitable availability and ecologic accessibility of enhanced Primary Healthcare for 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 A more extensive presentation of 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 in the grey panel to your right. You will need to scroll to the top of this Page to find it. You will go immediately to that Sub-Page by clicking on it.
REFORM THROUGH INSTITUTIONAL CHANGE – Stage One ( 1 year ) 2019-2020
” 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 and not just metaphoric, as borne out subsequently by history. At a much different point in time nearly 350 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 hanging together to resolve the current status of hanging separately.
- COMMENT A new institution, NATIONAL HEALTH, will be required. The new institution would be Chartered by an act of Congress and constituted thereafter within 6 months during 2020. The Charter would prohibit any involvement in the direct reimbursement of 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 annual 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. Three specific GOALS must be achieved as certified by the President to Congress. They are: 1) to decrease health spending as a portion of the national economy from @18% to 13% or less of its Gross Domestic Product (GDP), 2) to decrease our nation’s annual maternal mortality incidence by 70% and 3) to 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 responsibility for coordinating its locally focused Survival Commons, beginning with its equitable available 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, a community is intended to comprise, on average, @400,000 citizens. Conversely, for sparsely populated areas, a community might comprise only 100,000 citizens. Ultimately, NATIONAL HEALTH would be most visually identifiable by its nearly 800 Community HEALTH Forums. The basis for establishing a Community Health Forum can be found on 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 also be required. First, NATIONAL HEALTH will establish a Basic Health Benefits Plan to define the minimum benefits for reimbursement by all the sources of economic support for comprehensive healthcare. For the second national project, a certification process will be established to identify enhanced Primary Healthcare as a basis for augmented reimbursement by the sources of economic support for comprehensive healthcare. Finally, NATIONAL HEALTH will coordinate with all the various stakeholders a Plan to manage a career-long, professional growth process for all Primary Healthcare Clinics’ personnel.
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 the President. During 2020, it would be held in St. Louis, Missouri. It is the largest city that is closest to the geographic population center of the United States.
STABILIZE HEALTH SPENDING – Stage Two ( 4 years ) 2020-2024
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’ increased by 2.18% compounded annually. This increased ‘health spending’ represents growth at a rate of 2.18% faster than economic growth.
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 a benchmark of 13% for these nations and 17.8% for our GDP in 2018, the excess ‘health spending’ for our nation in 2018 would have represented $1.00 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) of 3:1, 7:1 for early childhood education and 4:1 for anticipatory disaster mitigation projects. 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 deficit for 2018 and @50-60% during the interval years prior to 2018. Our nation’s Federal government is headed to bankruptcy principally on the burden of our nation’s annually increasing, health spending.
- COMMENT Initially, each community’s Community HEALTH Forum will evaluate the adequacy of its own equitably available, enhanced Primary Healthcare. Patterns of deficiency will be evaluated and a long-term plan for its implementation approved by each community’s Community HEALTH Forum. Nearly 800 communities would be involved, each defined for a citizen population of @400,000 citizens. NATIONAL HEALTH would offer development and training systems for each Forum. The ongoing support 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 as adequate level of Social Capital within each 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 that ultimately shape 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 affected by the underlying economic growth rate as promoted by a slowing of annually increased health spending. A sustained increase of annual economic growth will also improve our national Well-Being, indirectly improving it for every citizen.
Stable HEALTH for Each Citizen -Stage Three ( 5 years ) 2024-2029
SOCIAL CAPITAL
The institutional and health spending issues should be considered as preliminary phases for solving the quality problems of our nation’s healthcare. Many of these have root causes that originate from within the “…mindless menace of violence…” that afflicts most communities. The processes for enabling the level of social capital within each community will eventually be required to mitigate the prevalence of its 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 neglect/abuse, adolescent suicide/homicide, substance addiction, mass shootings, obesity, homelessness, mid-life depression/disability, and declining longevity at birth 2014-2018.
The OECD (Organization for Economic Cooperation and Development) regularly reports maternal mortality trends from among its 35 member nations. For the last 25 years, the United States is the only nation among the OECD nations with a worsening incidence of maternal mortality. From 1990 thru 2015, the average maternal mortality incidence of the OECD nations decreased from 32 to 14 deaths per 100,000 live births. The United States is the only advanced/developed nation with a worsening maternal mortality ratio during the last 30 years.
In 2015, there were 3,978,497 live USA live births. Analysis of the data indicates 1,040 maternal deaths in 2015. It is possible to assume that at least 600 of these women died in 2015 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 best maternal mortality incidence, at least 600 of the 1040 deaths in 2015 might 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 Capital from their Community HEALTH Forum activities will eventually reduce ou 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
The Global market-place arenas for its Resources, Knowledge, and Human Dignity will likely require a means to plan and promote a unified process for the 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 our citizens as a portion of the worldwide population are probably shrinking.
We should firmly recognize the pervasive level of cognitive dissonance that exists within the global market-place 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 managed and broadly sanctioned new strategy.
- COMMENT: The new strategy should be equitably decentralized and steadily adjusted as its performance continues to evolve. We must pursue continued improvements in quality and cost that will achieve a stable portion of our national economy allocated to health spending, ideally 11-12%.
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 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 hand-written document for a “care plan” during an office visit had for many years helped me to improve the precision of the final plan during any person’s, health care appointment.
* 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 these new realms of Knowledge as I have attempted to arrive at an expanded understanding of HEALTH. The recognition of Paradigm Paralysis afflicting healthcare reform has prompted the search for a new strategy for healthcare reform. This Paradigm renewal is vitally important as a basis to sustain this new strategy. Ten new definitions further define the national implications for implementing this new strategy.
* REVISION LOG The underlying character and introduction of new ideas 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.
This is the only Sub-Page that you can set-up as a follower. That way, you know “what’s up” when I have made a substantial update.
This page has the following sub pages.
