NATIONAL HEALTH usa

S o c i a l    C o h e s i o n

G  O  A  L  s

16 pages                                                                            —   1   —  

INTRODUCTION

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; and 

To know even one life has breathed easier 

because you have lived.

This is to have succeeded.”

Ralph Waldo Emerson    (1803 – 1882)

“We are here on earth to live, grow up, and do

what we can do to make this world a better place

for all people to enjoy freedom.”

Rosa Parks    (1913 – 2005)

   ^

“I have learned that people will forget what you said,

people will forget what you did,

but people will never forget how you made them feel.”

Maya Angelou    (1928-2014)

Most likely, Ralph Waldo Emerson was truly the author of the SUCCESS poem.  Several other authors published similar versions during the 19th century.  The Emerson version still resonates best with its special presence for defining the pursuit of a person’s life.  This presence would be a worthy attribute for the involvement of anyone, such as a Community Advocate, who is locally willing to support the fundamental reform of our nation’s Population Health as well as its Healthcare.  Most importantly, Rosa Parks and Maya Angelou remind us that we survive by how well we care for and about each other.

   I suspect that one underlying attribute, among many, of each person’s healthcare is competition.  Specifically, this competition can occur daily among the economic, professional, or moral priorities of each healthcare provider, unexpectedly and even unintentionally, in subtle ways.  To achieve the attributes of individual success as described by Emerson, any person – professional provider or not – who is dedicated to improving the  Unstable HEALTH  of another person will need to steadily adapt the dominant priorities of their obligations.  These continually reassessed priorities would then promote a commitment *) to eliminate any awareness or motive of unbalanced competition during the moral reasoning that occurs during each health care encounter and *) to carefully self-examine the relevant, apparent or real, conflicts of interest: be they ethical, professional, social, or economic. 

   To disengage these conflicts of interest, the descriptive term that would be most applicable is ‘enlightened reasoning.’  Enlightened reasoning would apply to the multitude of interacting dimensions that underlie the character of any encounter for healthcare, not just the economic factors.  For any professional caregiver, what could healthcare reform do to improve the institutional support during their professional career, especially for a Primary Physician?  This institutional priority should focus on supporting each caregiver’s commitment to nurture an enduring caring relationship with each person during any health care encounter.

   The simultaneously diverse dimensions connected with an episode of health care can rise to an overwhelming level of complexity.  These diverse dimensions may involve a consideration of timeliness, information precision, diagnostic assessment specificity, therapeutic options, as well as patient acceptance.  Each person’s individual needs then occur within a larger scenario of social interaction spontaneity, relevant documentation, resource allocation, and their ethical issues especially beneficence and futility. 

   Currently, the traditions of our nation’s healthcare do not adequately support a commitment to consider these healthcare dimensions carefully during each healthcare encounter.  Redirecting our nation’s healthcare traditions to improve the alignment of these institutional dimensions is an underlying goal for the  NATIONAL HEALTH Proposal  as focused by its associated set of  PRINCIPLES.  Striving to achieve Emerson’s state of “Success” could be a multi-dimensional yardstick for anyone contributing to our nation’s healthcare, especially when this health care is offered with a daily awareness of  ‘enlightened reasoning.’      —   3   —

enhanced  PRIMARY  HEALTHCARE

The  NATIONAL HEALTH Proposal  would engage the national, regional, and community stakeholders to support a renewal of Primary Healthcare for the Basic Healthcare Needs of each community’s resident persons. The community-based focus of the New Strategy would rely on the  PRINCIPLES  of Altruism, Trust, Cooperation, Reciprocity, and Excellence to promote the Global  Tasks applicable for assuring the availability and accessibility of enhanced Primary Healthcare by each resident person of every community.  To benefit from these Operational Statements, the  NATIONAL HEALTH Proposal  would specifically promote the formation of local efforts to assure that enhanced Primary Healthcare steadily becomes equitably available to and ecologically & culturally accessible by each resident person within their own community.  This New Strategy would encourage the locally engaged stakeholders to join a nationally promoted, collaborative process for resolving the neighborhood inequities associated with the availability and accessibility of their own community’s enhanced Primary Healthcare.

   With the assistance of Four National Projects, the New Strategy would support every community’s commitment to develop their enhanced Primary Healthcare with an awareness of prosociality during any person’s health care for their Basic Healthcare Needs.  Slowly but surely, enhanced Primary Healthcare would be refocused by its connection with  NATIONAL HEALTH.  Beginning with Primary Healthcare, the character of this health care should curate comprehensive Care Plans that incorporate a person’s Basic Healthcare and their Extended Family within any Complex Healthcare required by a resident person.

   With Primary Healthcare at the leading edge of its paradigmatic reform, ‘enlightened reasoning’ would then become an essential attribute for reconfiguring our nation’s Population Health as well as its Primary Healthcare.  The increased attention to a careful reconciliation of the competing attributes applicable to each episode of health care would support the reforms necessary to release the paradigm paralysis afflicting our nation’s entire healthcare industry.  Between 1969 and 2009, the evolving paradigm that occurred was the result of a rapidly evolving improvement in the level of specialized healthcare that was available for Complex Healthcare Needs.  The healthcare for Complex Healthcare Needs has economically evolved in the absence of a corresponding improvement in our nation’s health care for Basic Healthcare Needs.

   To resolve the current paradigm paralysis afflicting our nation’s healthcare, a high level of ‘enlightened reasoning’ as an attribute of enhanced Primary Healthcare could induce the day-to-day synergy necessary for steady change.  Within fifteen years, unlocking the paradigm paralysis affecting our nation’s Population Health and its Primary Healthcare will be especially necessary given  1) our changing worldwide community,  2) the “mindless menace of violence” affecting each community, (Kennedy 1968)  and  3) the financial-resources deficiency currently available for achieving the equitable availability of enhanced Primary Healthcare for each resident person, community by community.  For each Primary Healthcare Team Member who supports the new strategy of the  NATIONAL HEALTH Proposal,  a commitment to promote their prosociality priorities will be their pathway to an inner presence of “Success” as described by Ralph Waldo Emerson.  —   5   —

– – – – – –      initial   GOALs      – – – – – –

The Congressional Charter would define the initiating and continuing governance for  NATIONAL HEALTH  and its  GOALs.

I. NATIONAL HEALTH  Charter provisions

            A. Identify 9 Regions as a State or group of contiguous States, each Region encompassing its own nearly equal portion of our nation’s total population; 

            B. Establish a Board of Trustees with nine Members, each eventually selected by their respective Regional Council’s Board of Directors, on a 9-year rotating process that is scheduled by a Plan to achieve a balanced representation of Members who together represent the nationally applicable Population Health related Humanitarian and Scientific Stakeholders;  (Note: 37.6 million citizens

encompased by each Region per 2020 census)  

            C. Establish nine Regional Council offices in accordance with the Plan for the Board of Trustees, *) for the responsibilities assigned to each Regional Council by the Board of Trustees for the operational governance of  NATIONAL  HEALTH,  *) for advice and consent with the Board of Trustees regarding the preparation and revision of Operational Statements, and  *) for offering technical support to 90 Community HEALTH Forums within their Region; 

            D. Locate the Home Office of  NATIONAL  HEALTH  near the geographic population center of the USA including Hawaii, Alaska, and its protectorates, viz., Saint Louis, Missouri;

            E. Fund its affairs solely from an annual Federal allocation of $1.50 per citizen based on the proceeding year’s Census estimate and an annual COL adjustment originating the year following the last annual Meeting of the Board of Trustees  AND  allocated  *) to the expenses authorized by the Board of Trustees for itself or its Regional Councils  or  *) to a  NATIONAL HEALTH  “rainy day fund;” 

            F. Prohibit any operational associated involvement with  *) the direct intermediary distribution of economic reimbursement for any resident person’s health care or healthcare or *) the operational funding of any Community HEALTH Forum, other than technical support for operational affairs; 

            G. Maintain and periodically revise a Design Epistemology to guide any future reconfiguration plan for our nation’s Population Health and its Primary Healthcare; and 

            H. Achieve its  GOALs  steadily without major internal distractions or risk a 2-Stage Sunset notification by the President with either  *) an Emergent 6-month termination notice or  *) a 2-year provisionally contingent termination notice.

A preliminary proposal for the initial  GOALs  of   NATIONAL  HEALTH   would represent the following: 

I. Implement Four  NATIONAL  PROJECTS  within 2 years for assuring the sustainable availability of enhanced Primary Healthcare that is offered to each resident person in every community and monitored as an annual reduction of our nation’s maternal mortality rate by 70% within 15 years: 

      A. Establishing a  PRIMARY HEALTHCARE  BENEFITS  PLAN  as a set of minimum standards  *) to define the healthcare benefits eligible for the financial support of each resident person’s Basic Healthcare Needs by any form or source of economic resources and  *) to define the alternate options for the augmented financial support for  ‘HEALTH Security’  certified Primary Healthcare; 

      B. Coordinating an evolving statement for a  PRIMARY CARE PROVIDER  EDUCATION  PLAN within each of our nation’s Northeast, Southeast, and Western Regional medical schools as a general format for the undergraduate and postgraduate education of physicians as the basis for Regionally assuring the uniform availability of Primary Physicians who individually accept a personal responsibility to maintain an annually mentored Career Formation Accord by continuously acquiring the adaptive skills necessary for the  PRIMARY HEALTHCARE  BENEFITS PLAN; 

      C. Establishing a  HEALTH SECURITY  CERTIFICATION  PLAN   for the clinics offering enhanced Primary Healthcare as the basis  *) to improve each person’s health care for their Basic Healthcare Needs including its coordination with any Complex Healthcare Needs and  *)  to apply their clinic’s augmented financial support to offer broadly enhanced Primary Healthcare;     AND 

      D. Establishing a national  PRIMARY HEALTHCARE  EFFICACY  PLAN for Primary Healthcare health spending with a deeply-nested, monitoring system to assess the stop-loss protected, financial performance of all primary care providers of healthcare that recognizes national health spending as a Common Pool Resource and incorporates all payers for the eligible reimbursement of healthcare within a State or a protectorate.  (NOTE: The  PLAN  will include an evolving set of definitions including provisions for healthcare provided to a resident person outside of the continental States, Alaska, Hawaii, or its protectorates.) 

II.  Sponsor a  NEW  STRATEGY  to uniformly improve our nation’s Population  HEALTH  as measured by every State’s legislative collaborative authorization to participate with the affairs of  NATIONAL HEALTH within 15 years to:

      A. Promote at least 810  Community HEALTH Forums throughout our nation that are individually comprised of multiple counties or a portion of one county to encompass, on average, 400,000 resident persons each as the basis to define an annually revised Community HEALTH Plan to assure that equitably available as well as ecologically and culturally accessible, enhanced Primary Healthcare is offered to each of their community’s resident persons as the basis to reduce the annual health spending for our nation’s healthcare as a portion of our nation’s economy;                                                                         —   7   —

      B. Resolve the uniquely generational, locally-driven ecologic and cultural community traditions that adversely impact certain resident persons within every community by including within each Community HEALTH Forum’s, CommunityHEALTHplan  *) an annually reviewed and revised Master Disaster Preparedness Plan that assures a connection with its contiguously adjacent communities as well as their State and Federal preparedness plans,  *) an assessment of the community’s  Survival Commons (aka safety net),  especially any deficits applicable to neighborhood safety, nutritional access, affordable and code-enforced housing, early childhood education, homelessness prevention, as well as employment entry; and  *) a global community measurement tool for assessing changes over time in the relative level of Social Capital within a Forum’s community;     and

      C. Establishing a tradition to form supportive social networks with their respective, mutually contiguous nations, states, and communities as a basis to collaborate for preventing, mitigating, and ameliorating the pervasive occurrence of Human Dignity disasters by the Board of Trustees, each Regional Council, and each Community HEALTH Forum to enhance our nation’s Social Cohesion as measured by the diverse measurement tools for Social Capital trends. 

             AND 

III.  Achieve widespread, broadly based national support for the affairs of  NATIONAL HEALTH  and its  PRINCIPLES  of Altruism, Trust, Cooperation, Reciprocity, and Excellence as measured by an annually steady reduction in the portion of our national economy that is devoted to Health Spending by 30% within 15 years by:

            A. Achieving supportive ratification of its Congressional Charter

                        by 30 states within 5 years,

            B. Recognizing the officially operating existence of 

                        500  Community HEALTH Forums  within 5 years,

            C. Recognizing 30,000  HEALTH SECURITY  certified

                        Primary Healthcare clinics within 5 years, and   

            D. Implement ‘Primary Healthcare Clinic’ Efficacy Reporting

                        within 2 States of the Northeast, Southeast, and

                        Western Mega-Regions within 5 years.

    In fact, it is likely that a slowing of the annual increase in health spending to a level that is less than economic growth will, in and of itself, support improved economic growth.  From an accounting viewpoint, the underlying objective is to lower health spending increases to a level that is 0.5% less than economic growth. For instance, if economic growth was 3.0% for 2019, any increase in annual health spending during 2020 should be 2.5% or less.  By assuming that health spending growth was annually 1/2 of 1% less than economic growth, it would only take 10 consecutive years to achieve health spending that represented 13.0% of our national economy.  For perspective, health spending as a portion of our nation’s gross domestic product (GDP) was 5% in 1960 and 18% in 2019.  Remember also, our nation’s Federal Government pays cash for 45% of our nation’s excess health spending. 

   The  NATIONAL HEALTH Proposal  will likely need to prioritize its daily affairs to establish a widely-supported affirmation of its  GOALs  and their related implementation.  Each State will need their own legislature’s agreement to collaboratively participate in the affairs of   NATIONAL HEALTH.   It is likely that the participation of each State’s relevant humanitarian and scientific Social Networks would benefit from a full scale vetting sequence that begins immediately after Congress acts to Charter the establishment of  NATIONAL HEALTH.  Of note, the ultimate benefit of the Proposal may be lost amidst its publically associated turmoil., viz., its underlying effect to improve our nation’s social cohesion, community by community.

   In addition, the initial  GOALs  will reduce the number of women who die as a result of a pregnancy. As monitored by standards of the European-based ‘Organization for Economic Cooperation and Development (OECD), the maternal mortality ratio for our nation worsened from 15.1 in 2005 to 17.4 in 2018. Meanwhile, the 14 European nations with the best maternal mortality levels averaged 5.0 in 2005 and 3.9 in 2018. Using the statistics for 2018, the  NATIONAL  HEALTH  Proposal’s GOALs for decreasing maternal mortality by 70% would mean that at least 400 of the 600 women who died with a pregnancy in 2018 would have still been living in 2021.  The number tends to be ignored, for complex reasons, since there were nearly 4 million births in 2018. When women die in association with a pregnancy, the Human Dignity presence lost by their Family is profound, especially for each of these Families who already have additional children.

GETTING STARTED

When the initial Meeting of the Board of Trustees occurs, the time clock for  NATIONAL HEALTH  will start. During the 2022-23 session of Congress, submitting the authorizing legislation for  NATIONAL HEALTH  to the President should be the number one task by 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 Resident Person, community by community, could also be a factor for reducing the “mindless menace of violence” described by Senator Robert Kennedy during his Presidential campaign in 1968.       —   9   —

   Improving the equitable availability, ecological & cultural accessibility, just efficiency, and dependable 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 specialists’ expertise for each narrowly defined health condition.  This scenario has progressively reduced the precision applied to every resident person’s Population HEALTH as well as their Healthcare. 

   In the absence of enhanced Primary Healthcare, the reduced precision has especially affected our resident persons who have multiple Complex Healthcare Needs, especially for its social adversities.  For a Federal fixed cost of $1.50 per resident person annually,  NATIONAL HEALTH  would establish a locally focused and precisely coordinated reform of our Population Health traditions.  The New Strategy also represents an effort to mobilize local and regional resources to assure that the health care for Basic Healthcare Needs is uniformly improved, community by community.

   Each newborn infant, every disabled or homeless resident person, and all women during and after a pregnancy are waiting.  For at least  “1”  of every  “20”  of our nation’s resident persons, tomorrow may not be soon enough!

 – – – – – –      future  GOALs      – – – – – –

OUR  CHILDREN’S  CHILDREN,  REQUIRE  NO  LESS 

The Congressional Charter should define only the broad initial  GOALs  for the future affairs of  NATIONAL HEALTH.  The Congressional Charter would  PROHIBIT  any long-term involvement with the direct distribution of economic support for any resident person’s health care.  The importance of  NATIONAL HEALTH  for our nation’s healthcare lies in its precisely defined obligation to avoid any conflict of interest that promotes a deficient commitment to the humanitarian mandate as compared to the scientific mandate for our nation’s health care.  Currently, the institutions that pay for our nation’s healthcare also substantially determine the benefits eligible for this reimbursement.  This conflict-of-interest, among others, would be reduced since the Congressional Charter would assign to  NATIONAL HEALTH  the responsibility for determining the minimum standards applicable to any definition of the healthcare eligible for the economic support of each resident person’s Primary Healthcare.     

   Eventually, the affairs of  NATIONAL HEALTH  would encounter ‘other needs’ for the  HEALTH  of each resident person.  Any future  GOALs  may not begin to be definable until 6-7 years after the initial Meeting of its 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 resolving the deficiencies of social cohesion that already exist within each community.  As of now, these deficiencies could prompt  NATIONAL HEALTH  to eventually:

(*)  Foster a national dialogue about a continuously revised Comprehensive National Risk Management Plan, locally adapted community by community, for any national disaster requiring a locally coordinated response by our nation’s healthcare industry, such as an unforeseen pandemic or catastrophic earthquake along the oceanic coast of Washington, Oregon, and California; 

(*)  Focus the affairs of  NATIONAL HEALTH  to emphasize equitably available as well as ecologically and culturally accessible health care for each resident person’s Basic Healthcare Needs as the basis to avoid any future economic need to ration the healthcare for Complex Health Needs.  This economic need should be governed by an ethical standard that is informed by the justly efficient use of resources;  AND

(*)  Sponsor a continuously renewed assessment of the future requirements for the evolving reform of our nation’s healthcare industry that reflects an ANTHROPOCENE perspective regarding the  Knowledge,  Resources,  and  Human Dignity  applicable to each resident person’s  Stable HEALTH.                                                              —   11   —

RISK  MANAGEMENT 

If another serious worldwide pandemic were to occur, who would establish the locally applicable  ‘medical TRIAGE’  processes necessary for the appropriate use of limited national healthcare resources? During an unusually 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 resident persons with breathing distress from an influenza pandemic would be young 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. Unfortunately, the COVID-19 pandemic has not responsively initiated a focused reconciliation of the proposals formulated for its amelioration by our current combination of public and private institutions.