f o r H E A L T H C A R E R e f o r m
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 )
” Its 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 – )
Before 1860, healthcare always occurred within the home of each person’s Family or Extended Family. Exceptions for many people occurred with hunting/gathering, war-time, and poverty as in current day homelessness. Beginning @1860, healthcare began to increasingly move out of a person’s home to another institutional location. 150 Years later, each person’s healthcare has now become the responsibility of persons who usually have a limited, if any, 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 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 technical basis for healthcare is now associated with institutional governance problems within our nation’s healthcare industry, especially its economic needs. And, for a community, each citizen’s Family has lost one of its traditional means for sustaining the relationships among its Extended Family members.
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- In effect, the historical evolution of contemporary healthcare has now jeopardized the resilience of each community’s Social Capital. 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 their Common Good for the benefit of its citizens.
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To augment each community’s Common Good, our nation’s healthcare industry will require a new strategy to solve its current level of institutional paralysis. This new strategy must include a means to assist each community to strengthen its own Social Capital asset over a period of 10-15 years. To initiate this plan, the new strategy would begin with a special focus on the equitable availability of enhanced Primary Healthcare for every citizen, community be community. The comprehensive renewal of Primary Healthcare will be necessary to ultimately resolve the over-all cost and quality problems of our nation’s healthcare.
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- A more extensive presentation of these new concepts can be found by clicking on the A 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
“We must, indeed, all hang together,
or most assuredly we shall all hang separately.”
Benjamin Franklin ( 1705 – 1790 )
One can only imagine the 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 born 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 a precise focus for the reform of our nation’s healthcare industry.
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- A new institution, NATIONAL HEALTH, will be required. The new institution would be Chartered by Congress and subsequently affirmed within 3-5 years by the Legislature of each State. 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 each individual State. Finally, it would be financed by a fixed annual budget of $1.00 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.
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NATIONAL HEALTH, as implemented by its semi-autonomous Board of Trustees would implement three national projects to improve Primary Healthcare and a new strategy to promote community by community attention to managing its locally focused COMMON GOOD. 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.
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- For the purposes of NATIONAL HEALTH, a community is intended to comprise, on average, 400,000 citizens. Certain metropolitan areas might have several community designated regions for the purpose of ensuring that their community-wide COMMON GOOD receives equitable attention. 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.
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- Given Congressional authorization and Presidential approval, the initial Meeting of the NATIONAL HEALTH Board of Trustees could would occur within 9 months of the Congressional Charter’s approval by the President. It would be held in St. Louis, Missouri. It is the largest city that is close to the geographic population center of the United States.
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” H E A L T H S P E N D I N G ” – Stage Two ( 5 years ) 2024
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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 Gross Domestic Product (GDP). For 2016, ‘health spending’ represented 18.0% of the GDP. During the intervening 56 years, ‘health spending’ increased 5.0% compounded annually as corrected for economic growth and inflation.
Since 1995, the United States has progressively allocated a larger portion of our gross domestic product (GDP) on ‘health spending.’ Using data from the Organization for Economic Co-Operative Development (OECD) and its 35 member nations, we can learn that the other 34 nations substantially cluster around 12% of their GDP that was allocated to ‘health spending’ in 2015. Using a benchmark of 13% for these nations and 18% for our GDP, the excess ‘health spending’ for our nation in 2016 would have represented $1 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 increase in our nation’s ‘health spending’ paid by the Federal treasury (Medicare and Medicaid) now represents more than 80% of our nation’s Federal deficit for 2016. Our nation’s Federal government is headed to bankruptcy principally on the burden of our nation’s ‘health spending.‘
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- Equitably available, enhanced Primary Healthcare that is offered to each citizen will be evaluated and a long-term plan for its implementation approved by each community’s Community HEALTH Forum. Nearly 800 community’s 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 on going support would come from within their own community.
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The long-term function of each Community HEALTH Forum would focus on the segments of its neighborhoods and their level of participation in promoting the level of Social Capital within their community. Ultimately, this would involve a connection with the community’s COMMON GOOD and its responsiveness to the needs of its citizens for Stable HEALTH regardless of the disruptive events that shape each person’s life.
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.
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“Stable HEALTH for Each Citizen” – Stage 3 ( 5 – 10 years ) 2029 – 2034
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The institutional and cost 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 ennobling the Social Capital in each community will eventually be required for its mitigation. I propose that our nation’s annual incidence of maternal mortality should be the most important attribute of our long-term progress.
The OECD 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. From more recent reports, our nation’s maternal mortality incidence increased between 2000 and 2015 from 18.8 to 26.4 maternal deaths per 100,000 live births.
In 2015, there were 3,978,497 live USA live births. Analysis of the data indicate 1040 maternal deaths in 2015. It is possible to assume that at least 600 of these women died in 2017 because they were living in the wrong nation before the onset of their pregnancy. If they had been living within 1 of the 10 nations within the OECD with the best maternal mortality incidence, they would still be alive. These nation’s have an average maternal mortality incidence that is 75% lower than the United States.
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- The State by State improvement for its available and accessible Primary Healthcare and improved level of Social Capital from their Community HEALTH Forum activities will reduce the nation’s maternal mortality ratio by 75%. 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.
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S U B – P A G E S
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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. This 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 communicate about them with the written word.
Personally, I am still an advocate of the hand written 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 a person’s, health care appointment.
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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.
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A 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. This has occurred for me as I have tried to arrive at a new definition of HEALTH as the fundamental basis to pursue a new strategy for healthcare reform.
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REVISION LOG The underlying character and introduction of new ideas has occurred fitfully, over the last ten years. In 2014, I began to document the pace and character of its evolving concepts. 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.
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This page has the following sub pages.
