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
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,
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* 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.
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* 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;
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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
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* 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;
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* 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.