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NATIONAL HEALTH

A New Strategy to release the Paradigm Paralysis of our Nation's HEALTHCARE

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e n l i g h t e n e d      c o m p e t i t i o n

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G  O  A  L  S

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.                                    

INTRODUCTION

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SUCCESS

  

                                                       “To  laugh  often  and  much; 
                                                         To  win  the  respect  of  intelligent  people  and
                                                                     the  affection  of  children;
                                                         To  earn  the  appreciation  of  honest  critics  and  
                                                                     endure  the  betrayal  of  false  friends;
                                                         To  appreciate  beauty;
                                                         To  find  the  best  in  others;
                                                         To  leave  the  world  a  bit  better,  whether  by  
                                                                      a  healthy  child,    
                                                                      a  garden  patch  or  
                                                                      a  redeemed  social  condition;
                                                         To  know  even  one  life  has  breathed  easier  
                                                                      because  you  have  lived.
                                                         This  is  to  have  succeeded.
Ralph  Waldo  Emerson      ( 1803 – 1882 )

      

                   

Most likely, Ralph Waldo Emerson was the author of this poem.  Several other authors published similar versions during the 19th century.  The Emerson version still resonates best with its special presence for defining the successful pursuit of a person’s life.  This presence would be a worthy attribute for the involvement of anyone who is willing to support the fundamental reform of our nation’s healthcare during their lifetime.  With the special involvement of these citizens as an Advocate for each Community HEALTH Forum,  the mindfulness of  “Success” could also be an effective counterbalance to the pervasive “mindless menace of violence” passionately described by Senator Robert Kennedy in 1968.

I suspect that one underlying attribute, among many, of each citizen’s healthcare is competition.  Specifically, this competition can occur among the economic, professional or personal priorities of the healthcare provider, unexpectedly and unintentionally, in subtle ways.  To achieve the attributes of individual success as described by Emerson, each ‘provider’ citizen contributing to improving the  Stability  of another citizen’s  HEALTH  will slowly need to acquire a renewed set of priorities for their work.  These special priorities would promote a commitment to eliminate any awareness or motive of unbalanced competition during the decision process for a health care encounter and to openly acknowledge any relevant, apparent or real, conflicts of interest: personal, professional or economic.  To disengage these conflicts-of-interest, the descriptive term that would be most applicable is: ‘enlightened competition.’  Enlightened competition would apply to the multitude of interacting dimensions that underlie the character of any encounter for health care, not just the economic factors. For any professional care giver, what can healthcare reform do to improve the institutional support of a professional career, especially for a Primary Physician, with a daily commitment to sustain a  caring relationship  during each citizen’s encounter?

The simultaneously diverse dimensions connected with an episode of health care can rise to an overwhelming level of complexity.  These dimensions may involve a consideration of timeliness, information precision, diagnostic assessment diversity, therapeutic options, citizen acceptance,  caring relationship  needs, relevant documentation, resource allocation as well as ethical issues, especially autonomy, beneficence and futility.  Currently, the traditions of our nation’s healthcare do not adequately support a commitment for considering these healthcare dimensions carefully during every health care encounter. Redirecting our nation’s healthcare traditions to improve the alignment of these dimensions is an underlying goal for proposing the  NATIONAL HEALTH  Initiative  and its associated  V A L U E S.   Striving to achieve Emerson’s state of “Success”  could be an informal goal for anyone contributing to our nation’s healthcare, especially when this health care is offered with a daily awareness of  ‘enlightened competition.’

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enhanced   PRIMARY  HEALTHCARE  

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The  NATIONAL HEALTH  Initiative  would sponsor its own set of Operational Statements to support a renewal of Primary Healthcare for the Basic Healthcare Needs of each citizen.  These Operational Statements would promote broadly based Collaboration to promote the  Global Institutional Tasks  necessary for the expansion of enhanced Primary Healthcare, community by community.  To benefit from these Operational Statements, the  NATIONAL HEALTH  Initiative  would specifically support the formation of local efforts to assure that enhanced Primary Healthcare is equitably available to all citizens, community by community.  

With the assistance of three national projects, this  new strategy  would support the evolution of enhanced Primary Healthcare with an awareness of ‘enlightened competition’ for reconciling the dimensions affecting the outcome of any encounter for health care.  Slowly but surely, enhanced Primary Health Care would be refocused by its connection to the  NATIONAL HEALTH   V A L U E S  of  Altruism,  Collaboration,  Excellence,  Transparency  and  Trust.   Beginning with Primary Healthcare, promoting ‘enlightened competition’ would eventually augment the character of the health care for the Complex Healthcare Needs required by each citizen.

With Primary Healthcare at the leading edge of change, ‘enlightened competition’ would become an essential attribute for our nation’s entire healthcare industry.  The increased attention to a careful reconciliation of the competing attributes applicable to each episode of health care would support the reforms necessary to redirect the paradigm paralysis afflicting our nation’s entire healthcare industry.  Between 1969 and 2009, the paradigm shift that had occurred was the result of a rapidly evolving improvement in the level of specialized health care available for Complex Healthcare Needs.  The health care for Complex Healthcare Needs has evolved in the absence of a corresponding improvement in our nation’s health care for Basic Healthcare Needs, especially its community based equitable availability.  

To resolve the paradigm paralysis afflicting our nation’s healthcare, a high level of ‘enlightened competition’ as an attribute of Primary Healthcare would produce the day-to-day synergy necessary for change.  In ten years, unlocking the paradigm paralysis affecting our nation’s healthcare will be especially necessary given  1) our changing world-wide community,  2) the  “mindless menace of violence”  affecting the community of each citizen  and  3) the deficient financial resources currently available to sustain the equitable availability of enhanced Primary Healthcare for each citizen, community by community.  For each Healthcare Team Member who supports the  new strategy  of  NATIONAL HEALTH,  a commitment to ‘enlightened competition’ will be their pathway to an inner presence of  “Success”  as described by Ralph Waldo Emerson.

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initial  GOALS

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A Congressional Charter would define the  initial  GOALS  for  NATIONAL HEALTH.   A preliminary view would represent the following:  

 

I.  Establish  THREE  NATIONAL  PROJECTS  for the healthcare of each citizen by –   

           *  Maintaining a  NATIONAL  PRIMARY HEALTHCARE  BENEFITS  PLAN  as a set

                       of minimum standards to define the healthcare benefits eligible for the financial support

                       of Basic Healthcare Needs from any payment or other economic source within 4 years,

           *  Coordinating an evolving statement for a  NATIONAL  PRIMARY PHYSICIAN  EDUCATION  PLAN 

                       by our nation’s medical schools beginning in medical school as a basis to assure

                       the uniform availability of  Primary Physicians with the career-long adaptation of the skills required 

                       for the  NATIONAL  PRIMARY HEALTHCARE  BENEFITS  PLAN,  

                       and

           *  Establishing  HEALTH SECURITY  certification for enhanced Primary Healthcare as a basis 

                       ^  to improve each citizen’s healthcare for their Basic Healthcare Needs including 

                                   its coordination with any Complex Healthcare Needs   and

                       ^  to augment the financial support for Primary Healthcare;

  

II.  Sponsor a  NEW STRATEGY  for the reform of our nation’s healthcare industry by – 

           *  Promoting a  Community HEALTH  Forum  for each community of about 400,000 citizens   

                       throughout our Nation, each using collective action skills to define a  Community 

                       HEALTH Plan  that will achieve  equitably available  and, eventually

                       ecologically accessible,  Primary Healthcare for each citizen as the basis

                       for reducing the annual cost of our nation’s healthcare as a portion

                       of our nation’s economy (GDP)  by  5%  in 5 years and  25%  in ten years.  

                       and

           * Supporting the  HEALTH  SECURITY  certification of Primary Healthcare, 

                       community by community, that will achieve  justly efficient  and  

                       reliably effective  healthcare for each citizen as measured by an  70%  reduction

                       of our nation’s maternal mortality ratio over ten years;  

           AND  

  

III.  Achieve wide-spread, broadly based national support for the affairs of  NATIONAL HEALTH 

           and its   V A L U E S   of   Altruism,   Collaboration,   Excellence,   Transparency   and

           Trust   by:  

           *  Receiving ratification of its Congressional Charter by 30 states within 6 years,

           *  Recognizing the officially operating existence of  500  Community HEALTH Forums 

                       within 4 years  

                       and   

           *  Recognizing  30,000  HEALTH SECURITY  certified Primary Healthcare clinics

                       within 5 years. 

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The  initial  GOALS  will reduce the annual cost of our nation’s healthcare within  10  years by  26%  as measured by its portion of the annual gross domestic product.  For example, this would have represented a change from  18.2%  in 2016 to 13.4%  of our nation’s gross domestic product in 2026,  a reduction in 2026 that is the equivalent of  $912  Billion in 2016 dollars.  Remember, the faster our economic growth occurs between 2016 and 2016, the actual reduction in absolute health spending as a portion of our national economy would be less than the estimate for 2016 dollars within the 2026 GDP.

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In addition, the  initial GOALS  will reduce the number of women who die as a result of a pregnancy.  As monitored by the World Health Organization, the maternal mortality ratio for our nation will improve over  10  years from  42nd  worst in 2015 to  11th  or better among the  51  advanced/developed nation’s of the world in 2026. (12)   Using statistics for 2015, the decreased maternal mortality ratio  GOAL  would mean that  900  women who died with a pregnancy in 2015 would still be living in 2016.  The number tends to be ignored, for complex reasons, since there were nearly  4  million births in 2015.  The social capitol  lost to a  family  is profound.  To rank among the  10  nations with the best maternal mortality ratio in 2015 (Austria, Belarus, Czech Republic, Finland, Greece, Ireland, Italy, Kuwait, Poland, and Sweden), the number of maternal deaths in 2015 for our nation’s women should have been less than  200.  To understand the implications on the over-all HEALTH  within a  family  by a maternal death, see the  RATIONALE  Sub-Page for a contemporary Definition of HEALTH.   The level of denial within the current  PARADIGM  of our nation’s healthcare regarding maternal mortality is the most important attribute of is underlying paralysis.  

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When the  initial Meeting  of the Board of Trustees occurs, the time clock for  NATIONAL HEALTH  will start.  During the 2017 session of Congress, submitting the authorizing legislation for  NATIONAL HEALTH  to the President should be the number one task for the leadership of Congress.  The Board of Trustees could initiate its affairs within  6  months after the President’s signature.  Reforming our nation’s healthcare industry with a  V I S I O N  to achieve  Stable  HEALTH  For Each Citizen  could also be a factor for reducing the  “mindless menace of violence”  described by Senator Robert Kennedy in 1968. 

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Improving the availability, accessibility, efficiency and effectiveness of our nation’s healthcare industry is desperately needed. Since 1969, there has been an increasing tendency to define healthcare based on one, or more, specialist’s expertise for each narrowly defined health condition.  This scenario has progressively reduced the precision and focus of each citizen’s over-all healthcare.  In the absence of enhanced Primary Healthcare, the reduced precision has especially affected our citizens who have multiple Complex Healthcare Needs.  For a national cost of  $1.00  per citizen annually,  NATIONAL HEALTH  would establish a precisely coordinated reform of our nation’s healthcare traditions.  The  new strategy  represents an effort to mobilize local and regional resources to ensure that the health care for Basic Healthcare Needs is uniformly improved, community by community.

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Each newborn infant, every disabled or homeless citizen, and all women during a pregnancy are waiting.  For at least one of every twenty citizens, tomorrow is probably not be soon enough! 

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future  GOALS

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The Congressional Charter would not define any  future GOALS  for the affairs of  NATIONAL HEALTH.   The Congressional Charter would only eliminate any long-term involvement with the direct financial support of health services.  The importance of  NATIONAL HEALTH  for our nation’s healthcare lies in its precisely defined reduction of the conflict-of-interest that promotes a deficient commitment to the  humanitarian mandate  as compared to the  scientific mandate  for our nation’s healthcare industry.  Currently, the institutions that pay for our nation’s healthcare also largely determine the benefits eligible for this reimbursement.  This conflict-of-interest would be substantially reduced since the Congressional Charter would assign to  NATIONAL HEALTH  the responsibility of determining the minimum standards applicable to any definition of the healthcare eligible for the economic support of our nation’s Primary Healthcare. 

Eventually, the affairs of  NATIONAL HEALTH  would encounter other needs by our nation for the  HEALTH  of each citizen.  The  future GOALS  may not be clearly definable until 6-7 years after the  initial Meeting  of the Board of Trustees.  Given our nation’s heritage, it is possible that three attributes of our nation’s  HEALTH  would benefit from the future collaborative character of  NATIONAL HEALTH.   The  future GOALS  in ten years will probably evolve from the deficiencies of  social capital  that already exist within the current healthcare industry.  As of now, these deficiencies could prompt  NATIONAL HEALTH  to eventually:

            *  Foster a national dialogue about and a continuously revised Risk Management Plan, community by community, for any national or regional disaster requiring a special response from our nation’s healthcare industry, such as an influenza pandemic;

            *  Focus the affairs of  NATIONAL  HEALTH  to emphasize equitably available and ecologically accessible health care for Basic Healthcare Needs as a basis for any possible future economic need to ration the healthcare for Complex Health Needs;

                        AND

            *  Sponsor a continuously renewed assessment of the future requirements for the evolving reform of our nation’s healthcare industry.

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DISCUSSION 

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RISK  MANAGEMENT

If a serious worldwide influenza pandemic were to occur, who would establish the locally applicable decision processes necessary for the appropriate use of our limited national healthcare resources?  During a severe influenza outbreak, who would be authorized to identify the person with a severe illness who would have access to the last ventilator in a hospital’s intensive care unit?  The decision process would be especially difficult since many citizens with breathing distress from influenza would be children, and many adult hospitals may not be prepared for the number of victims who would be children.  Currently, a nationally defined   medical TRIAGE   process could be established by the combined efforts of Congress, the Public Health Service, the Surgeon General, our medical schools and each state’s Health Department.  At this time, there is no nationally sanctioned institution with community connections and broadly supported authority to reconcile the proposals formulated by this combination of institutions. 

 

This  Initiative  creates an opportunity for  NATIONAL HEALTH  to foster a national dialogue as a basis for planning any over-all decision structure applicable to a serious influenza pandemic or another disaster overwhelming our nation’s healthcare resources, be it regional or national.  With Congressional authorization of  NATIONAL HEALTH  and its subsequent role in promoting beneficial healthcare reform, it could eventually accumulate the nationally recognized and widely supported authority to sponsor a National Risk Management Plan for Healthcare.  Specifically, this sponsorship would foster an evolving, equitably efficient Plan for managing a regional or national Healthcare Disaster at the community level.  In effect, the ultimate benefit from  NATIONAL HEALTH  for our nation’s healthcare would be the result of separating the vested interests of the  economic mandate  to pay for our nation’s healthcare from the  social mandate  to arrange the greatest good for the greatest number of citizens.

  

JUSTLY  EFFICIENT  

   

Given the economic traditions of our nation’s healthcare, it may ultimately be too difficult or even unnecessary to eventually implement a uniform basis for the reimbursement of Complex Healthcare Needs.  The initial degree of wide-spread acceptance and support for the description of minimum Healthcare Benefits just for Basic Healthcare Needs may be the best predictor of any similar effort eventually applied to Complex Healthcare Needs.  The dialogue involved with establishing the minimum definitions for a national Certificate of Benefits will involve various compromises among the legitimate vested interests including a provision to allow State by State definitions for certain specific Benefits, such as for fertility.  Hopefully, a national Certificate of Benefits would also achieve a level of citizen trust that any, apparent or real, future level of rationing would be applicable to all citizens, especially in the event of a national or regional disaster.  To achieve this level of support, a high level of collaboration, transparency and trust, methodically sustained, would also establish wide-spread acceptance for the over-all actions of the Board of Trustees, its nine Regional Councils and their eighty-one District Coalitions.

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The formal governance for  NATIONAL HEALTH  would promote a  Community HEALTH Forum  for  @800 communities, each focused on the  HEALTH  of approximately  400,000  citizens.  Established through local initiative, each Community HEALTH Forum  would sponsor the collective action, community by community, for assuring that enhanced Primary Healthcare is equitably available to each citizen within their own community.  I propose that a widespread collection of Community HEALTH Forums  could also be the best means to assure that any national disaster plan involving our nation’s HEALTH  reconciles the national and regional needs with the availability of its locally applicable implementation.

  

The academic studies that formed the basis for  “Governing the Commons”  by Professor Elinor Ostrom are especially applicable to the shared use problems related to our nation’s healthcare.  Since 2009, our cost-plus healthcare industry has increasingly contributed to an impending bankruptcy of our national economy.  The 2009, slowly lingering recession, is symptomatic of this financial burden.  It is unlikely that the Accountable Care Act of 2010 will achieve a sufficiently efficient healthcare industry for resolving its  “Tragedy of the Commons.”   NOW  is the time to apply the collective action solutions defined by Professor Ostrom.  A Nobel Prize winner in 2009, she died in May of 2012.  In her honor, I propose a personal intent for this Blog.  The  initial Meeting  of the Board of Trustees should occur in May of 2018.   

      

CONTINUOUS  REFORM 

  

With a limited budget, the possibility of a more intense involvement in the day-to-day affairs of any citizen’s health care by  NATIONAL HEALTH  will be prevented.  Given a progressively more responsive and cost-effective healthcare industry, what then would be the continuing role of  NATIONAL HEALTH  for our nation’s healthcare?  The level of uncertainty given the future turmoil throughout our world is profound.  The world-wide community and its marketplace arenas for  RESOURCES,  HUMAN DIGNITY  and  KNOWLEDGE  is at stake.  We must never again allow the healthcare industry to jeopardize our nation’s autonomy within the world’s marketplace arenas, especially for its  Resources.  Very likely, a constant and continuously adjusted plan for healthcare reform will always be necessary for our nation.

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Continuously sponsored healthcare reform will be necessary for the  Stable HEALTH  of Each Citizen,  especially as it contributes to reducing our nation’s pervasive level of violence.  This reduction would be most-precisely measured by a reduction of our nation’s death rate from homicide and suicide for citizens aged 1 year thru 24 years.  In 2010, it was  25%. (43)   With the investment in the  social capital  asset of each community by  NATIONAL HEALTH,  I propose a goal of reducing this rate to  20%  of all deaths within this age group.  The presence of  800  Community HEALTH Forums  could have a sentinel benefit of a reduction to  17%.   A reduction in the level of violence along with healthcare reform would represent a broad measure of nationally improved  social capital  through the presence of  NATIONAL  HEALTH.   A community based means of healthcare reform may be our most valuable national asset as we re-focus our nation’s  autonomy  in the world’s marketplace arenas for its RESOURCES,  KNOWLEDGE  and  HUMAN DIGNITY.   The future heritage of our nation within the world-wide community is at stake.

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S  U  B  P  A  G  E  S

 

* supportive  GOALS            The initial function of  NATIONAL HEALTH  focuses on the importance of enhanced Primary Healthcare for the promotion of a precisely focused healthcare industry characterized by a high level of efficiency and effectiveness.  When the initial benefits of this effort begin to demonstrate success, other attributes of our nation’s healthcare may demonstrate the need for focused attention.  This Sub-Page represents one view of long-term needs of our nation’s HEALTH  potentially benefiting from the focused analytic experience of  NATIONAL HEALTH.

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* GENERAL  OPERATING  PRINCIPLES            Promoting a responsive and inclusive focus for the affairs of NATIONAL HEALTH  will be difficult.  Meaningful healthcare reform will need a national level of good will and commitment probably not witnessed since WWII.  To sustain this level of good will and commitment, I propose that a carefully crafted system of  OPERATIONAL STATEMENTS  could more precisely define the boundaries for promoting reform every day as the Congressional Charter becomes a widely supported reality.  This Policy establishes a clearly defined structure as the basis for the governance required to achieve successful healthcare reform.

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* initial   GOVERNANCE            Of essential importance to begin with a good start, the governance of  NATIONAL HEALTH  should represent carefully considered judgement beginning with the  initial Meeting  of its  Board of Trustees. The Members attending the  initial Meeting  should represent the result of a unique and expedient selection process.  Three years after the  initial Meeting, a permanent selection process would become active.  The selection processes at the beginning and eventually merge into the permanent process should be defined by the Congressional Charter.  This  Sub-Page  describes a proposal for the initial selection process.  

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* STRATEGIC  PROJECTS  PLAN            The  GENERAL OPERATING  PRINCIPLES  Policy would require several Procedures to implement its governance intent.  The most important of these is this Procedure with its broad plan for achieving the  GOALS  of  NATIONAL HEALTH.  This  Sub-Page  represents a concept for discussing the possible attributes of an optimal starting point for the affairs of  NATIONAL HEALTH. 

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This page has the following sub pages.

  • * supportive GOALS
  • * OPERATIONAL PRINCIPLES
  • * initial GOVERNANCE
  • * initial STRATEGIC PLAN
  • * initial MBO TIMELINE

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