189 years ago
A P P E N D I X
INTRODUCTION
“I cannot help fearing that men may reach a point
where they look on every new theory as a danger,
every new innovation as a toilsome trouble,
every social advance as a first step toward revolution,
and that they may absolutely refuse to move at all.”
Alexis de Tocqueville ( 1805 – 1859 )
Alexis de Tocqueville arrived on our shores in 1831 from his home in France. He traveled widely in our country for the next two years. I wish I could have heard directly from him about what he had heard or seen that led him to write the opening citation above. Did he have a premonition about the possibility of paradigm paralysis within the new American republic? We will never know. Some 189 years later, the level of cognitive dissonance associated with the reform of our nation’s healthcare industry now affirms this quotation.
This Page represents an effort to provide supplementary information for understanding the NATIONAL HEALTH Initiative. A brief description is given below for each of the Sub-Pages of the APPENDIX Page.
S U B – P A G E S
BIBLIOGRAPHY I list the specific sources of information cited on the Blog. The notation configuration is atypical since the theme of this Blog site does not support a common Bibliography for multiple Pages and Sub-Pages.
GLOBAL TASKS A national industry that spent $3.65 Trillion in 2018 (17.8% of the GDP) will require a carefully defined plan to guide its successful reform. Particularly important would be a need to achieve a high level of precision, a VISION, for a clearly focused process of change. NATIONAL HEALTH would apply two highly structured, conceptual models to support a commitment to pursue precision. First, the use of a GLOSSARY to define specific terms, such as healthcare and health care. The other conceptual model is a recognition of 5 separate Global Institutional Tasks for describing the operational tasks of NATIONAL HEALTH. They are: ORGANIZE systems, PURSUE vision, BUILD community, MANAGE resources, and DEVELOP skills. To enhance their use, the Blog avoids the use of these verbs in any other context, especially as a noun or adjective. The word “organization” is never used when we mean institution, “management” when we mean leadership, or “development” when we mean improvement.
AVAILABLE & ACCESSIBLE There are barriers that interfere with the ability of health care to be reliably effective and justly efficient. The basic definitions for reliably effective and justly efficient as well as equitably available and ecologically accessible may be found on the GLOSSARY for HEALTHCARE Sub-Page. Available and accessible as related to health have special characteristics. To explore these dimensions further, this Sub-Page describes the healthcare availability issues for a person who wakes up one morning with a bad cough. A person facing the deficient availability of health care for Basic Healthcare Needs is a root-cause for the severe inefficiency of our nation’s health care. Given its variable availability and its related accessibility, the analysis of Basic Healthcare Needs and the current paradigm paralysis of our nation’s healthcare industry represents the basis for a recommendation to implement the NATIONAL HEALTH Initiative.
FIVE HEALTH STORIES The lives of five people, who are fictional, describe the difficulties currently encountered by many citizens who have Complex Healthcare Needs. These stories, drawn from real-life events, describe five different scenarios for people with severely Unstable HEALTH. Their HEALTH is representative of the 16 million citizens who use 70-80% of our nation’s healthcare spending. Reducing this burden without stringent rationing will be the essential challenge for our nation’s healthcare reform. Since probably 50% of this high-burden group changes annually but probably are not clearly identifiable in advance, anyone who takes 5 or more medications regularly needs a complete health assessment within 6 weeks after their first visit at a Primary Healthcare clinic. The complete evaluation should conclude with the preparation of a personalized comprehensive care plan including its regularly scheduled, future reassessment. Establishing a comprehensive care plan might also apply to anyone who is on any medication taken regularly or age 60 years or more.
“MINDLESS MENACE…” The “Mindless menace of violence throughout our land” defined the character of a brief speech that Senator Robert Kennedy gave twelve times during his brief Presidential campaign during 1967 and 1968. This Sub-Page begins with a quotation from the day he gave the speech for the last time. He gave it the day after The Reverend Doctor Martin Luther King, Jr. died. Two months later Senator Kennedy also died from the same violence. The historical events in 1968 and their connection with our national heritage serve to magnify the complexity underlying the character of our nation’s Survival Commons for each citizen, community by community.
“PARKINSON’S LAW” This is the title for a small book written by C. Northcote Parkinson and first published in 1957. The book is best characterized on the inside of its cover page for the 1964 edition. It says: “Everyone has heard of Parkinson’s Law — but how many can say what it means? For those who can’t, this book is a devastatingly accurate description of how administration really works in government, business, and every human group.” A bit of hyperbole, you say. “Maybe and maybe not!” say I.
intellectual PROPERTY Assuming that Congress might actually establish NATIONAL HEALTH, what is the likelihood that it would still be functioning 20 years later as implemented by the initial MEETING of its Board of Trustees? “Very low” would be my answer. None the less, the possible existence for 20 years would be the best measure of its success.
On the other hand, the concepts underlying the scale of NATIONAL HEALTH would promote the collaborative use of collective action for a completely new strategy for healthcare reform. To conceive of larger arenas for change could be the only conceptual value for the intellectual PROPERTY of this Blog. Specifically, we must renew on a much larger scale for a new reconciliation between the humanitarian and scientific mandates for our nation’s healthcare.
I will leave all of this for others to establish or claim, especially considering the multitude of meaningful contributors. If there is one person to acknowledge, it is Professor Elinor Ostrom. I would dedicate any lasting recognition of NATIONAL HEALTH to her memory.
This page has the following sub pages.