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H  E  A  L  T  H  C  A  R  E        R  E  F  O  R  M

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F  O  R        T  H  E        T  W  E  N  T  Y  –  F  I  R  S  T        C  E  N  T  U  R  Y

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—   s t a r t i n g     i n     2 0 1 6   —

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INTRODUCTION 

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“No  act  of  kindness,  no  matter  how  small,  is  ever  wasted.”

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Aesop      (  620 – 564 BC )

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“Consideration  for  others  is  the  basis

for  a  good  life,  a  good  society.”

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Confucius      ( 551 – 479 BC )

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“I  shall  pass  this  way  but  once;

any  good  that  I  can  show  to  any  human  being,  let  me  do  it  now.

Let  me  not  defer  nor  neglect  it,  for  I  shall  not  pass  this  way  again.”

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Etiene  de  Grillet      ( 1773 – 1855 )

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“The  best  way  to  find  yourself  is

to  lose  yourself  in  the  service  of  others.”

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Mahatma  Gandhi      ( 1869 – 1948 )

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“The  language  of  citizenship  suggests

that  self-interests  are  always  embedded  in  communities  of  action

and  that,  in  serving  neighbors,  one  also  serves  one-self.”

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Benjamin  R.  Barber      ( 1939 –      )

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Please read the opening quotations, again.  As represented by these authors, this view of life is similar to my own.  Do you also share this view of life?  If so, you will probably agree with the next sentence about our nation’s healthcare.  The current efforts to reform our nation’s healthcare industry will do nothing to improve the Basic Healthcare for one of every two citizens.  As an average, one out of every two citizens spend an average of $90.00 a month on Basic Healthcare.  Currently, this healthcare is often hard to locate or driven primarily by the timer on the computer screen.  For TRUE healthcare reform, a nationally sanctioned plan should promote enhanced Primary Healthcare that is eventually equitably available to and culturally accessible by every citizen.

For healthcare reform, I use the words “nationally sanctioned” to mean locally initiated, community sponsored, regionally supported and nationally promoted.  And, I use the word “enhanced” to mean that this Primary Healthcare offers health care with the skills to achieve  Stable  HEALTH  For Each Citizen.

Next, please accept the concept that fundamental healthcare reform must have, at its origins, a strategy that is closely connected to improving the level of social capital within each community of 400,000 citizens.  As a basis for healthcare reform, a ‘social capital’ investment sponsored by  800  separate communities may represent just too many unknowns.  However, if the community hypothesis could be even a small starting point for healthcare reform, please read on.

Reading the remainder of this  HOME  Page takes about 20 minutes.  It describes a plan that is intended to release the paradigm paralysis currently strangling our nation’s healthcare industry.  A paradigm shift will be required to release the unfocused power and sophistication of our nation’s healthcare.  To induce this paradigm shift, a  new strategy  should begin, at first, to slowly build momentum.  And then, more rapidly, it should revitalize the  social  and  economic mandates  of our nation’s healthcare with a renewed focus on the Basic Healthcare Needs of each citizen, community by community.

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FIVE   DEFINITIONS   –   LET’S   BEGIN  

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Five basic concepts can represent the basis for a serious discussion of healthcare reform. Each of these concepts has not achieved a widely accepted consensus for their precise connection with the other four basic concepts.  To improve our understanding of healthcare reform, each of the five concepts can be defined to represent a concise and powerful  interconnection.  As you will eventually perceive,  these concepts represent the basis for promoting a new, nationally inclusive, healthcare reform strategy.  This  new strategy  will rely on a nationally constituted, community by community strategy to achieve improved effectiveness and efficiency.  The five basic concepts are:   HEALTH,   CARING RELATIONSHIP,   SOCIAL CAPITAL,   COMMON GOOD   and   INSTITUTION.

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H E A L T H   –   may  be  defined  as

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a  person’s  daily  expression  of  survival  that  is

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Endowed  by  the  person’s  unique  cluster  of   human capabilities,

sufficient  for  survival  at  birth;

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Nurtured  by  the   caring relationships   originating  from  within  the  person’s   family

and  offered  before  birth  with  a  commitment  to  foster  the  fulfillment

of  the  person’s  emotional  and  intellectual   human capabilities;

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Transformed  by  the  person’s  life-long  participation  in  the   family traditions

initially  of  their  parents’  and  subsequently  of  their  own   extended family,

each   extended family   offering  the   caring relationships   for  surviving

the  traumatic  events  occurring  during  the  person’s  life-time;    AND

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Sustained  by  the   common good   of  the  person’s  community

until  the  person’s   human capabilities   are  no  longer  sufficient  for  survival.

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C A R I N G    R E L A T I O N S H I P    may  be  defined  as

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a  variably  asymmetric  interaction

between  two  persons,  over  time,  who  share  a   beneficent   intent

to  enhance  each  other’s   autonomy   by  communicating

with   warmth,   non-critical acceptance,   honesty   and   empathy.

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S O C I A L    C A P I T A L    may  be  defined  as

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an  attribute  of  a  community’s  citizens  and  their  local  institutions

that  represents  a  pervasive  commitment  to  use   caring relationships

for  achieving  the  success  of  any   collective action   strategy  intended

to  resolve  an  isolated  deficiency,  left  unattended,

 among  the   clusters of benefits   of  the  community’s   common good.

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C O M M O N    G O O D    may  be  defined  as

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the   clusters of benefits   for  a  community  that  are

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Instituted,  initially  and  maintained  thereafter,  by  the  community  to

“…secure  the  Domestic  tranquility…”  and  “…promote  the  general  Welfare…”

of  its  citizens  as  permitted  by  a  previously  defined  national  authority;  (xx)

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Offered  equitably  and  justly  to  each  of  the  community’s  citizens

who  may  choose  those  benefits  most  suitable

for  their  own  ecological  and  cultural  environment;

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Renewed  by  the  community’s  focused  and  steady  investment

in  the  assets  of  the  community’s   social capital;

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Sponsored  by  the  community  and  its  individual  citizens,  private  institutions

as  well  as  government,  at  all  levels;

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Enhanced  by  the  community’s   safety net   for  the  prevention,

anticipation  and  response  to  the  occurrence  of  certain  disastrous  events

associated  with  life-threatening  effects  on  the  survival  of  multiple  citizens;    AND

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Supported  by  the  community’s  connection  with  its  instituting  government  and

the  nation’s  level  of   autonomy   within  the  world’s  market-place  arenas

of   Resources,   Knowledge   and   Human Dignity.

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I N S T I T U T I O N    may  be  defined  as

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“…the  rules  that  humans  use  to  organize  all  forms

of  repetitive  and  structured  interactions  including  within

families,  neighborhoods,  markets,  firms,  sports leagues,  churches,

private associations,  and  governments  at  all  scales.

Individuals  interacting  within rule-structured  situations

face  choices  regarding  the  actions  and  strategies  they  may  take,

leading  to  consequences  for  themselves  and  for  others.

The  opportunities  and  constraints  individuals  face  in  any  particular  situation,

the  information  they  obtain  or  are  excluded  from,  and  how  they  reason

about  the  situation  are  all  affected  by  the  rules  or  absence  of  rules

that  structure  the  situation.   If  the  individuals  who  are  crafting  and  modifying

the  rules  do  not  understand  how  a  particular  combination  of  rules

affects  the  actions  and  outcomes  in  a  particular

ecological  or  cultural  environment,  rule  changes  may  produce

unexpected  and,  at times,  disastrous results.” (45)

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Given the heritage of our nation’s healthcare and these five definitions, I offer a new view of healthcare reform.  This  new strategy  for the reform of our nation’s healthcare industry must initiate and sustain a lasting focus on the community.  There are nearly endless priorities within this focus for healthcare reform.  Among these, I propose that only two priorities are important for healthcare reform.

First, our nation’s healthcare industry must eventually offer health care that is equitably available for the Basic Healthcare Needs of each citizen.  This health care should reflect caring relationships as defined above, thoughts spanning more than 2,500 years.  A locally driven commitment to assuring a caring relationship between each citizen and a Primary Physician should represent the essential attribute of enhanced Primary Healthcare.  To sponsor enhanced Primary Healthcare for each citizen, certain nationally focused institutional changes must initially occur.

The improvement of healthcare at the community level requires three nationally defined and sanctioned projects.  These national projects are necessary to successfully achieve locally driven healthcare reform.  They are:  1)  an evolving and nationally sanctioned comprehensive statement of  “best practices”  to achieve and sustain the educational preparation of sufficient Primary Physicians for the Basic Healthcare Needs of all citizens;  2)  a set of minimum definitions to use as the basis for the optimal financing of Primary Healthcare  and  3)  a  HEALTH SECURITY  certification process for enhanced Primary Healthcare as a basis for its eligibility to receive augmented financial support.

Second, for healthcare reform to be successful, it should promote an annual assessment of Primary Healthcare and its equitable availability, community by community.  The Design Principles necessary to manage a common-pool resource through “collective action” as defined by Professor Elinor Ostrom would guide this assessment.  Applied to each community averaging about 400,000 citizens, a local Community HEALTH Plan for all communities would represent nearly 800 nationwide.  Each Community HEALTH Plan would sponsor the locally driven improvements necessary to reduce the inequities identified by its annual assessment of Primary Healthcare, especially its availability.  A locally focused, volunteer effort will be necessary.  Fortunately, citizen volunteerism has existed since our nation’s inception.  Beginning more than  500  years ago, the enduring level of this volunteerism may be our nation’s most sustaining heritage.

Thus, local healthcare reform should begin throughout our nation with the formation of locally led and properly constituted volunteer groups, each to be known as a communityHEALTHcooperative  ( cHc )  or  HEALTH Co-Op.   This reform process should be especially attentive to our nation’s remote communities, be they urban or rural.  With a focus on equitable availability, each cHc would represent a community-wide collective action process to sponsor the solutions necessary for the local needs existing within each community.  At a minimum, each annually revised  Community HEALTH Plan  would eventually assure that enhanced Primary Healthcare is equitably available for the Basic Healthcare Needs of each citizen.  Certified as “enhanced,” each Primary Healthcare clinic would offer a therapeutic community for health care that would also be culturally accessible, justly efficient and reliably effective.

By first promoting enhanced Primary Healthcare, each local cHc would also be the appropriate vehicle to assess any other community adversities that interfere substantially with the ability of certain citizens or citizen groups to achieve  Stable  HEALTH.   It is likely that certain determinants of  HEALTH  would be common in most Community HEALTH Plans, such as the needs for early childhood education, adolescent health especially fertility and venereal disease, homelessness outreach and the local involvement of each community in our nation’s disaster preparedness commitment.  All of these efforts would still be the ultimate responsibility of the local, regional and national institutions that currently exist.  The ultimate role of each cHc would be to promote the community driven strategies necessary to achieve Stable  HEALTH  For Each Citizen  starting with their Basic Healthcare Needs.

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MISSION  TO  THE  MOON 

          

Unintentionally, the traditions of our nation’s healthcare industry have interacted since 1969 over many years to paralyze its capacity to initiate and perpetuate its own reform. To reverse this level of paralysis, a supreme national commitment to a thoroughly reconsidered basis for healthcare reform will be required.  A commitment to this level of reform should represent our nation’s next  “mission to the moon.”

Ten years from now, I propose three very specific  GOALS  for a  “moon-shot”  level of reform:  1)  reduce the total cost of our nation’s healthcare to  13.4%  of the annual gross domestic product,  2)  reduce the number of women dying from a pregnancy to a  3.4  maternal mortality ratio and  3)  achieve legislative ratification by all States of a Congressional Charter for a new nationally constituted, semi-autonomous institution to guide this reform.  Over ten years, these  GOALS  would:  reduce  the expense of our nation’s healthcare within our nation’s economy by  25%,  decrease  the number of our nation’s women dying from a pregnancy by  80%  and  establish  NATIONAL HEALTH  as a new, widely recognized and thoroughly supported institution to sponsor the permanently evolving reform of our nation’s healthcare industry.

For 2015, the total cost of our nation’s healthcare was  $3.3  trillion.  Lowering its total cost by  25%  would have represented a savings of  $825  billion for our nation’s economy in 2015 alone.  Of the total cost for healthcare in 2010, the local and state governments paid  16%  and the federal government paid  29%.  At  45%  of our nation’s healthcare, lowering its total cost by  25%  would have reduced the cost to all levels of government  in 2015  alone by  $371  Billion.  These funds are not currently available for deficit reduction, early childhood development or our deteriorating infrastructure.

The $3.3 Trillion cost of our nation’s healthcare during  2015  represented  18.0%  of the gross domestic product (GDP).  For any nation, the GDP is a measure of its total economic activity during a calendar year.  For all the other developed nations of the world, the cost of their healthcare represented  13%  or less of their GDP during 2013.  In 2012, the Medicare Office of the Actuary projected that the cost of our nation’s healthcare will reach 19.6%  of the GDP in  2021  including the provisions of the Accountable Care Act of 2010. (42)

According to an analysis published in 2012 by the World Health Organization, our nation’s maternal mortality ratio in 2010 ranked  38th  worst among the  43  developed nations of the world.  Reducing this rate by  80%  would have achieved a ranking for our nation among the best  25%,  instead of the worst  15%  of these nations.  Beginning in 2001 and ending in 2006, four states had already achieved a maternal mortality ratio that was 75%  less than our nation’s over-all rate.  If Alaska, Indiana, Maine and Vermont could be successful, surely all the other states can work steadily toward this achievement.

True healthcare reform must ultimately improve the efficiency of our nation’s healthcare industry.  To this end, healthcare reform must begin by achieving the uniform availability of Primary Healthcare for each citizen, especially for infants, the disabled and the homeless, as well as all women during a pregnancy.  To achieve success, this healthcare reform will require a precisely defined, highly focused, carefully implemented and locally initiated strategy.  This strategy should have a “mission to the moon” intensity but without a high lift-off cost.  A national cost of $1.00 per citizen annually would be enough. Investing in the social capital for locally driven, permanently instituted healthcare reform should be guided by a set of broadly inclusive  VALUES.   These  VALUES  would serve as a unifying reference point for the entire spectrum of healthcare reform – be it national, regional or local.

      

“NATIONAL   HEALTH” 

    

To understand the basics of healthcare reform, I began in 2008 with a search for concepts, newly reconsidered, as a possible basis to promote meaningful change.  My search included realms of knowledge not normally considered within the arena of healthcare knowledge.   By understanding the social contract underlying a developed nation, my search began to slowly identify the concepts applicable to a newly considered, fundamental reform of our nation’s healthcare industry.

To assess the validity of these concepts as a basis for healthcare reform, I prepared the  TRADITIONS  Page  and its  Sub-Pages  to serve as a possible root-cause analysis of our nation’s healthcare problems.  This analysis indicated that a “mission to the moon”  level of precision and intensity will be necessary for healthcare reform.  Defined with a “mission to the moon”  focus, a new institution should begin by promoting healthcare reform, community by community.  To achieve this end, I describe the  Global Tasks  for the operational functions of a new institution, NATIONAL  HEALTH,  on the  Initiative  Page and its Sub-Pages.

Locally initiated and promoted, the social capital created by fundamental healthcare reform could also become a linchpin for preserving the future autonomy of our nation within the world-wide community.  A new institution would be vital as a basis to guide the permanently evolving reform of our nation’s healthcare industry.  This new institution would be sanctioned initially by an Act of Congress and eventually ratified by the legislature of each State.  The authorization by Congress  and  by the legislature of each State will be necessary to achieve the level of national commitment that will be ultimately required for the successful reform of our nation’s healthcare.

Without nationally sanctioned healthcare reform, the safety net for each citizen and our nation’s economic stability within the world-wide community will eventually become compromised.  Currently, our nation has become a debtor nation.  As a result, our nation’s autonomy within the world’s market-place for its  RESOURCES  has become increasingly unstable.  Reducing the cost of our nation’s healthcare by a few billion dollars a year will be important during the first year true healthcare reform but irrelevant during the next nine years.

Based on 2015 data, we need to progressively reduce the cost of our nation’s healthcare with-in the over-all national economy by at least  $82.5  Billion annually  during each of ten successive years.  If  NATIONAL  HEALTH  had started in  2015  with this reduction plan, the total cost of our nation’s total healthcare would eventually have represented 13.4% of our nation’s economy in the year 2025.  Synergy and a precisely defined, healthcare-reform plan should be the rule.

Since the cost of our nation’s healthcare was  18.0%  of the national economy in 2015, the current piecemeal effort will not work.  Beginning today,  “lift-off”  for  NATIONAL  HEALTH  could be six months away.  Reducing the portion of our nation’s economy allocated to the cost of healthcare, from  18.0%  to  13.4%,  would require a reduction of 2.5%  annually for ten years. Our nation’s survival within the world-wide market-place for its  RESOURCES  will depend on it.  Success will require a new era  “mission to the moon” Project, as adapted to our nation’s healthcare reform.

Created by a Congressional Charter for the benefit of our nation’s future, each citizen would eventually recognize the  MISSION  of the new institution by its name: NATIONAL  HEALTH.   I propose the following  V I S I O N,  MISSION  and  VALUES  for this new institution:  

  

V I S I O N   –   Stable  HEALTH  For Each Citizen

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MISSION   –   To sponsor healthcare reform

with a continuously renewed understanding of our nation’s

RESOURCES,   KNOWLEDGE   and   HUMAN  DIGNITY

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VALUES   –   Altruism,   Collaboration,   Excellence,   Transparency,   Trust

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GETTING  STARTED  

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To understand the dimensions of healthcare reform, I turn to a brief history lesson. The history lesson answers the following question.  What is the heritage of our country that has evolved from the passions of the immigrants who have come here from foreign lands?  To be sure, many passions have motivated the men and women who have chosen, and continue to choose, emigration from their homeland to North America.  Among these motivations, three passions probably represent the essential heritage underlying emigration. One passion has been a desire to leave their nation’s authoritarian, autocratic, centralized and often coercive government.  A second passion has been a desire to become a citizen of a nation with constitutionally defined, and enforced, freedom of speech.

Beginning in 2001, the world’s continuing and rapidly evolving events represent the beginning of a new era for the world-wide community.  This new era clearly demonstrates the threat to individual freedom when living in a nation with an autocratic, authoritarian, centralized and coercive government.  According to the  NEWSEUM  in 2014, only  9%  of the world-wide human population, outside of the United States, lived in a nation that protected freedom of speech, as in our First Amendment rights.

The third motivation for immigrants has been, and still is, the chance to start a new way of life.  Building a new way of life was especially prominent for the early immigrants who came to North America and endured life-threatening hardships.  Most early immigrants accepted, in advance, the profound and unknown personal dangers of these hardships.  It was a small price to pay for the chance to build a substantially and permanently better quality of life.  Traveling to North America and leaving “taxation without representation” was, and continues to be, worth these life-threatening risks.

Unfortunately, many immigrants have come to our nation for other reasons.  Human trafficking has forced and continues to force many immigrants to emigrate for the profit motives of their captors.  Legally prohibited by the 13th Amendment to our Constitution in 1865, the forced loss of dignity for the African emigrants was and continues to be a devastating failure of our nation’s commitment to uniformly honor and promote the HUMAN DIGNITY  of all citizens  Other immigrants have come to this country only to serve their own predominantly self-centered economic or social values.  And finally, the early foreign immigrants forced Native Americans to emigrate and, as a result, become immigrants on their own land.

Our nation’s legal tradition of assumed property rights drove this immigration by our Native Americans.  In 1879, Native Americans finally achieved protection under the law from a Federal Court decision in Omaha by Judge Elmer Dundy for Chief Standing Bear of the Ponca Tribe.  For this decision, two attorneys who worked for the Union Pacific railroad had prevailed with a writ of “habeas corpus ad subjiciendum.”

Despite the reasons for immigration, successful survival in North America has always required self-discipline, hard work and altruism, a desire to help others. For  500  years, this dedication to individual survival was associated with an expectation that each community would function better if its citizens survived primarily on their own in spite of life’s tragic events. For the  12  million immigrants who arrived in New York City at Ellis Island, any healthcare that was eventually available to them was a privilege based on the economic success of their own individual survival. The immigrants who passed through Ellis Island represent the ancestors for nearly 40% of our nation’s current citizens, including my own from Sweden.

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PARADIGM  SHIFT   

                   

Beginning in  1970,  a rapidly evolving improvement has occurred in the sophistication of health care that is available for Complex Healthcare Needs.  Unfortunately, the improved quality of health care for Complex Healthcare Needs has not been matched by a similar improvement in the health care for Basic Healthcare Needs.  This change in the last 47 years means that self-discipline, hard work and altruism no longer guarantee that healthcare is equitably available for the Basic Healthcare Needs of all citizens, even by the citizens who have achieved economic success.  Inadequately available health care for Basic Healthcare Needs can be especially profound  *) for any woman during a pregnancy and  *) for any citizen who is an infant, homeless or disabled.

By 2009, the poorly recognized imbalance that had evolved between the health care for Complex Healthcare Needs as compared to Basic Healthcare Needs represents the most difficult problem for healthcare reform to resolve.  The health care for Basic Healthcare Needs has suffered from the absence of any nationally sanctioned means to assure that Primary Healthcare was equitably available to and culturally accessible by each citizen in every community.  The effect of this has led to severe problems within our healthcare industry, as in its bankrupting efficiency and unpredictable effectiveness.

The imbalance is the result of an inadequate level of both financial and social capital to support the Basic Healthcare Needs of each citizen as compared to their Complex Healthcare Needs.  It is not the fault of any one citizen or group of citizens.  It began to occur, more prominently, soon after Congress authorized Medicare and Medicaid. Between 1969 and 2009, the portion of our nation’s economy allocated to healthcare almost tripled.  Unfortunately, the flow of these resources preferentially into the health care for Complex Healthcare Needs has produced a deeply entrenched and pervasive institutional co-dependency between the institutions paying for complex healthcare and the institutions offering complex healthcare.  The institutional co-dependency represents a paradigm shift of colossal dimensions.  As a result of the paradigm shift, our nation’s healthcare industry is now unable to systematically offer health care for the Basic Healthcare Needs of each citizen and functions at a total cost that is no longer affordable by our national economy. As of 2009, our nation’s healthcare industry was functioning in a classic state of paradigm paralysis (20), institutional co-dependency at its worst.

The paradigm paralysis means that the heritage of our nation has also produced a healthcare industry unable to start or sustain its own reform.  Since 2009, the healthcare industry has needed a new and widely supported institution to guide its reform.  Our nation’s agriculture industry has had its Cooperative Extension Service since 1914, and our nation’s monetary policy has had its Federal Reserve since 1913.  Now, more than 100 years later, a similar institution for the healthcare industry must begin by focusing on promoting enhanced Primary Healthcare that is available  to  and accessible  by  each citizen, community by community.

Ultimately, our nation’s healthcare industry must improve its capacity to foster a local collective action heritage within each community.  This heritage would sustain a nation-wide, community-based process for recognizing their own obligation to promote the HEALTH  of each local citizen.  This  new strategy  should focus on the  HEALTH  of all citizens and, especially, the  HEALTH  of each infant and their mother.  Thirty years from now, our nation’s survival within the world-wide community will depend on improving our nation’s investment in the  social capital  necessary to foster a self-directed, caring and learning generation of citizens.

   

“GOVERNING  THE  COMMONS”

  

Because of its profound inefficiency, our healthcare industry is no longer affordable by our nation’s economy.  A  “Tragedy of the Commons”  has occurred. (30)  The traditions of our national heritage have led to this crisis.  Exploring the basis for remodeling these traditions is the central theme of this Blog.

Professor Elinor Ostrom points the way with her studies described in nine books published between 1990 and 2010.   “Governing the Commons” (31) is the first book in this series.  In this book and others, she describes an analysis of shared use strategies for the preservation of a natural resource, such as the fresh water aquifer under the city of Los Angeles, California. Her studies, along with the research of numerous colleagues, have defined the Design Principles for the governance of any institution with a responsibility to guide the reform of how an industry uses a common-pool resource, such as our nation’s annual economy.  In 2009, Professor Ostrom received a Nobel prize in economics for her research.

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NEW  CONCEPTS   

                         

For lasting healthcare reform, its foundation should include a continuing search for new concepts that would be uniquely applicable to the reform of our nation’s healthcare industry.  The search for these concepts should not imply any intent to start a new tradition or to match the institutional heritage of another nation.  Among the world’s developed nations, the traditions of our own healthcare industry are unique.  Given the unique traditions of our national heritage, this proposal for  NATIONAL HEALTH  or any other reform proposal should refine our traditions rather than replace them. The other developed nations of the world have adopted a variety of models for their own healthcare industry.  They are instructive but do not easily provide a specific model to duplicate for our nation.

The search for concepts potentially applicable to healthcare reform covers primarily the last 60 years.  Within the public arena, the concepts I have chosen are new to healthcare reform based on how they would contribute to meaningful reform of our own healthcare traditions. These conceptual strategies represent realms of knowledge formulated by a diverse group of authors.  After an evaluation of these concepts, I propose that, taken together, they represent a pragmatic basis for the comprehensive reform of our nation’s healthcare as described on the  Initiative  Page  and its  Sub-Pages.   

  

HEALTH  CARE  versus  HEALTHCARE:  A  NEW  ERA   

  

Given our pioneer heritage, the historic traditions of our nation’s healthcare industry have evolved, especially since 1969, into a diverse mix of institutions. This healthcare industry is also unpredictably unstable.  In 2011, an unexpected number of critical medications were no longer available for significant periods of time.  One year later, a failure to maintain quality control standards by a compounding pharmacy located in Massachusetts led to more than 75  deaths throughout our nation.  Their state’s Public Health Department failed to monitor the quality control standards used by the pharmacy. The regulatory failure ultimately contributed to the disaster.  Similar disasters involving compounding pharmacies in Tennessee and in Texas began to unfold at mid-year in 2013. Next, the opening phase of the National Health Insurance Exchange in October of 2013 was disheartening, at best.  And finally in 2014, the problems within the Veterans Administration represented a heart-wrenching failure to honor the heritage of our nation’s military.

Any reform strategy should proceed with caution given the risk of aggravating the already unstable institutions within the healthcare industry. Hopefully, a sudden increase in the shortage and safety of medications beginning in 2011 was only an isolated sign of instability rather than the initial phase of worsening turmoil.  The evolving reality of the 2010 Accountable Care Act could worsen this turmoil given its inability to fundamentally reverse the pervasive paradigm paralysis afflicting our nation’s healthcare.

To formulate a strategy for carefully defined and implemented healthcare reform, the  TRADITIONS  Page  and its  Sub-Pages  analyze the essential traditions of our nation’s healthcare and propose a set of  “root-cause” requirements for its reform.  Based on this analysis, the  Initiative  Page  and its  Sub-Pages describe a new institution.  This institution would have a unique governance for sponsoring the reform of our nation’s healthcare industry based on the “root-cause” analysis.

By incorporating the root-cause analysis,  NATIONAL  HEALTH  would improve each citizen’s health care for Basic Healthcare Needs by promoting enhanced Primary Healthcare that is equitably available, community by community.  To achieve locally responsive national uniformity, NATIONAL  HEALTH  would establish three national projects to support the capacity of our nation’s healthcare to serve the Basic Healthcare Needs of each citizen as defined by:  equitably available,  culturally accessible, justly efficient and  reliably effective.  Beginning with a focus on its  social mandate  rather than its  economic mandate,  sponsoring true healthcare reform should be the number ONE  national priority during  2016.  A precisely defined and highly focused “mission to the moon”  will be required.

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A  NEW  ERA:  CONTINUOUSLY  SPONSORED  REFORM   

                 

If you appreciate the fundamental value of concepts and ideas as a basis for shaping the future course of events, then you also have a unique perspective for considering the character of our nation’s healthcare.  Overall,  NATIONAL HEALTH,  as described, integrates concepts originating from the traditions of thought underlying the social contract for the governance of Western nations. They are: sociology, economics, physics, psychology, institutional diversity as well as medicine.  Let me introduce you to Eric Hofer, Leon Festinger, Carl Rogers, Thomas Kuhn, Lawrence Weed, Garrett Hardin, Peter Drucker, Stephen Covey and Elinor Ostrom.  As a basis for reform, the cohesion of their concepts as well as the aspirations of many other concerned individuals represent the essential momentum guiding the conceptual priorities for healthcare reform.

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“NATIONAL  HEALTH”  revisited   

                      

During the last 500 years, isolated episodes of supreme commitment and purpose have defined our nation’s history.  Remember, especially now, the voyage of the Mayflower in 1620, the Declaration of Independence in 1776, the Civil War ending in 1865 with an Amendment to the Constitution, our national commitment to World War II after Pearl Harbor in 1941, the mission to the moon after Sputnik in 1957 and the awareness of terrorism after the World Trade Center attack in 2001.  With a similar degree of supremely focused commitment and purpose, I propose that the cost of our nation’s healthcare could eventually be reduced to  11%  of the Gross Domestic Product including the cost of universal health insurance.  This commitment would also achieve available and accessible healthcare for each citizen, as measured by a maternal mortality ratio of less than  4.0,  a reduction that would have prevented nearly  500  maternal deaths during 2013.

It is not likely that the current direction of healthcare reform could achieve these results, either now or in the near future.  Instead, we must begin by first acknowledging the pervasive paradigm paralysis afflicting out nation’s healthcare. Importantly, this paradigm paralysis has compromised our nation’s survival within the world-wide community, especially within the market-place arena for its  RESOURCES.   Now is the time for a  new strategy  to promote the social capital necessary to improve the  HEALTH  of each citizen, community by community.

Simultaneously, rebuilding our national purpose with this social capital would be an important achievement as our nation encounters the likely unpredictable events of the future.  These unpredictable events will increasingly characterize the world-wide community.  Our nation’s autonomy within the world-wide community will be in serious jeopardy without economic stability and a secure safety net for our future citizens.

Once again, I recommend the concepts defined by Elinor Ostrom regarding collective action.  Together they represent the basic principles necessary to unlock the paradigm paralysis currently afflicting the health care for each citizen, healthcare that is neither justly efficient nor reliably effective.  The level of its inefficiency is especially profound.  Nearly  $1 trillion of the federal $4.9 trillion deficit from 2009 through 2011 represented the excessive cost of our nation’s healthcare to the Federal government.  Using the design principles defined by Professor Ostrom,  NATIONAL  HEALTH  could achieve the widely supported authority necessary to implement the strategies required at the national, regional and local levels for fundamental healthcare reform.  Along with a reduction in its cost as a percentage of the GNP from  18%  to  13%,  the most important measure of our nation’s healthcare reform would be a reduction of our nation’s maternal mortality ratio by  80%.

Remember, achieving universal health insurance for each citizen was the plan for the Affordable Care Act of 2010.  In spite of its deficiencies, it is a magnificent effort.  However, it is likely to worsen the national cost of our nation’s current healthcare industry.  And, it will do very little to sponsor the fundamental reforms necessary to achieve equitably available, enhanced Primary Healthcare for every citizen.

To begin fundamental healthcare reform, it should be locally implemented and nationally supported: community by community.  As cited above, former Senator Barber reminds us that  “The language of citizenship suggests that self-interests are always embedded in communities of action and that, in serving neighbors, one also serves one-self.”   NATIONAL  HEALTH  represents a means to achieve  Stable  HEALTH  For Each Citizen through “communities of action.”

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R E V I S I O N   L O G

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Basically, this WordPress hosting site offers a public venue for describing a new, conceptual frame-work for achieving systematic healthcare reform.  The hosting site is especially valuable for exploring the various realms of knowledge applicable to the reform of our nation’s healthcare.  The panel on your right represents a site directory.  The six  Pages  and their  Sub-Pages  can be directly accessed from this panel.  The  HOME  Page and the other six  Pages  can also be accessed using the tabs above the Banner.  NOTE: My favorites are the  EPILOGUE  and  PARKINSON’S LAW  Sub-Pages.

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2-27-2014      Abraham Lincoln delivered his Cooper’s Union address on the 27th of February in 1860.  Any one with deeply held reactions to the 2013 LINCOLN movie would be moved by reading this speech (see abrahamlincolnonline for a copy).  In memory of the Cooper’s Union address given more than 150 years ago, I have added a quotation from the speech to the  initial GOVERNANCE  Sub-Page of the  OVERVIEW  Page.      pjn

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5-24-2014      At last, I have finished an edit that began on 4-13-2014!  This edit added an emphasis that describes the importance of collective action for the daily affairs of NATIONAL  HEALTH.   The decision tool of collective action would guide the improvement of healthcare as a basis to promote  Stable HEALTH  For Each Citizen, community by community.      pjn

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7-19-2014      Today, I have begun the addition of provisions for the role of a communityHEALTHcooperative ( cHc ) to promote equitably available Primary Health Care, community by community.  Initially, each cHc would be accountable for promoting equitably available Primary Health Care for a community of approximately 400,000 citizens.  Within 2 years following the  initial Meeting  of the Board of Trustees, nearly 400  cHc  could be functioning.  Ultimately, each cHc  would also focus on the social determinants of  HEALTH  that substantially affects their own community.     pjn

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11-30-14      Another key concept “joins” healthcare reform.  I have now finished integrating the  communityHEALTHcooperative  concept into the fabric of the NATIONAL HEALTHCARE   Initiative.     pjn

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5-30-15      The Blog is now 6 1/2 years “young.”  Increasingly, I use several terms related to healthcare reform for very specific purposes.  These terms may be found on the DEFINITIONS  Sub-Page.  For the initial draft, I have now finished this  Sub-Page  for all the entries listed.  The definition of an institution is my favorite, taken from the “UNDERSTANDING  INSTITUTIONAL  DIVERSITY”  book written by Professor Elinor Ostrom and published in 2005.  Anyone with a desire to understand healthcare reform should read the book.      pjn

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11-8-15      Previously, there was a small number of different fonts spread-out over the  36 Pages  and  Sub-Pages  of the Blog.  This week there is now only one font.  For me, this font is easier to read.      pjn

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11-30-15      I began this trek  7  years ago this evening.  The immediate task at hand is an edit process that will allow any  Page  or  Sub-Page to be downloaded and be “read-ably” printed.      pjn

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02-14-16      The  DEFINITIONS  Sub-Page  continues to receive a nearly daily revision, especially  HEALTH,  CARING RELATIONSHIP,  COMMON GOOD  and  SOCIAL CAPITAL. The complexity of these terms is magnified by the addition of  INSTITUTION  as defined by Professor Elinor Ostrom.      pjn

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03-26-16      The definition of  HEALTH  uses a term  human capabilities  that is relatively new.  It appeared most recently in the definition of health as proposed by Sridhar Venkatapuram in his book,  HEALTH  JUSTICE,  2011.  I have defined  human capabilities  on the basis of two layers:  Basic Functions  and  Advanced Functions.  It may be found on the  DEFINITIONS  Sub-Page of the  OVERVIEW  Page.

The two-part division of  human capabilities  reflects a common medical practice that recognizes a non-treatable, progressive decline of homeostasis.  This  HEALTH  transition represents a change in the purpose of therapeutic measures for  Advanced Functions from “curative” to “palliative.” Human dignity, then, represents its over-riding ethical standard.  During this transition, the health care for Basic Functions is unchanged and often associated with a Hospice referral.  I anticipate that this definition for  HEALTH  will require a continuing reconsideration.      pjn

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5-22-16      The continuing attention to improve the  DEFINITIONS  for healthcare reform has sponsored a realization that the concept of a  communityHEALTHforum  lacks precision.  To improve this concept, I have chosen to acknowledge the agriculture industry.  This industry has achieved its success in part from the Co-Ops that formed to mobilize local resources, county-by-county, with a connection to the land-grant Agriculture Universities.  As authorized by Congress, the Morrill Acts of 1862 and 1890 established the special University based Agricultural Colleges, and the Smith Lever Act of 1914 established the Cooperative Extension Service, county by county.  Thus, the communityHEALTHcooperative, nicknamed  HEALTH Co-Op,  represents a replacement for the  communityHEALTHforum  label.

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Please remember that our nation’s agriculture industry produces more food with the resources applied than any other world-wide nation.  And, our nation’s healthcare industry produces lower  HEALTH  with the application of substantially more resources than any other world-wide nation.  Both of these outcomes are by wide margins.      pjn

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8-21-16      For the last 6 months, I have searched for an elusive connection among the core conepts of  NATIONAL  HEALTH.   The core concepts are:  caring relationships,  HEALTH,  social capital  and  COMMON GOOD.   Today, an initial attempt is complete.  It may represent a “manufactured” representation.  Even after continuing refinement, time will tell!      pjn

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