Population HEALTH and Its Healthcare Reform

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

                    

                    

                    

                    

                    

G  O  A  L  S

                     

                    

                   

                                   

                                                        

INTRODUCTION

                                                                  

                                                                 

SUCCESS

  

      

     

 

“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 )

     

      

Most likely, Ralph Waldo Emerson was the author of this first 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 each person’s life.  This presence would be a worthy attribute for the involvement of anyone, an Advocate, who is willing to support the fundamental reform of our nation’s healthcare during their lifetime.  With the special involvement of these persons as Advocates for a Community HEALTH Forum, the mindfulness of “Success” could also be an effective counterbalance to the pervasive “mindless menace of violence” passionately described in 1968 by Senator Robert Kennedy during his Presidential campaign.

I suspect that one underlying attribute, among many, of each person’s healthcare is competition.  Specifically, this competition can occur among the economic, professional, or personal priorities of each healthcare provider, unexpectedly and unintentionally in subtle ways.  To achieve the attributes of individual success as described by Emerson, each provider dedicated to improving the Unstable HEALTH of another person will slowly need to acquire a renewed set of priorities for their obligations.  These special priorities would promote a commitment to eliminate any awareness or motive of unbalanced competition during the decision process during each 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 healthcare, not just the economic factors.  For any professional caregiver, what can healthcare reform do to improve the institutional support for their professional career, especially for a Primary Physician?  This institutional priority should focus on supporting each caregiver’s commitment to sustain a fully engaged caring relationship during each encounter involving a person’s HEALTH.

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, patient acceptance, social interaction spontaneity, 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 to consider these healthcare dimensions carefully during each 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 as focused by its associated set of PRINCIPLES. Striving to achieve Emerson’s state of “Success” could be an informal yardstick for anyone contributing to our nation’s healthcare, especially when this health care is offered with a daily awareness of  ‘enlightened competition.’

                     

enhanced   PRIMARY  HEALTHCARE

                    

The NATIONAL HEALTH Initiative would sponsor its own institutional set of Operational Statements to support a renewal of Primary Healthcare for the Basic Healthcare Needs of each community’s resident persons.  These Operational Statements would rely on the PRINCIPLES of Altruism, Trust, Cooperation, Reciprocity, and Excellence to promote the Global Institutional Tasks applicable to the expansion of enhanced Primary Healthcare, community by community.  To benefit from these Operational Statements, the NATIONAL HEALTH Initiative would specifically prompt the formation of local efforts to assure that enhanced Primary Healthcare is equitably available to each resident person within their own community.  This new strategy would engage the locally prominent stakeholders with a collaborative process for resolving the neighborhood inequities underlying the availability and accessibility of each community’s Primary Healthcare.

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 from any encounter for the health care of Basic Healthcare Needs.  Slowly but surely, enhanced Primary Health Care would be refocused by its connection with the NATIONAL HEALTH  PRINCIPLES of  Altruism,  Trust,  Cooperation,  Reciprocity,  and  Excellence.   Beginning with Primary Healthcare, promoting ‘enlightened competition’ would secondarily refocus the character of health care offered to also coordinate the Complex Healthcare Needs of each person.

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 release the paradigm paralysis afflicting our nation’s entire healthcare industry.  Between 1969 and 2009, the paradigm shift that occurred was the result of a rapidly evolving improvement in the level of specialized health care that was 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 uniform availability and accessibility within each community.

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 each community, and 3) the deficient financial resources currently available to sustain the equitable availability of enhanced Primary Healthcare for each resident person, 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.

                                                               

                                                                                                 

initial  GOALS

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A Congressional Charter would define the initial GOALS for NATIONAL HEALTH and its underlying governance.  A preliminary proposal for the initial GOALs should represent the following:

 

I.  Establish THREE NATIONAL PROJECTS within 2-years for the healthcare of each resident person by

            *  Maintaining a PRIMARY HEALTHCARE  BENEFITS  PLAN as a set

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

                        of each person’s Basic Healthcare Needs by any form of economic resources,

            *  Coordinating an evolving statement for a PRIMARY PHYSICIAN  EDUCATION  PLAN

                        by our nation’s medical schools as the general format for the under-graduate and 

                        post-graduate education of physicians as the basis for assuring the uniform availability 

                        of Primary Physicians with the career-long adaptability to express the skills required

                        for the PRIMARY HEALTHCARE  BENEFITS  PLAN, and

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

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

                                   its coordination with any Complex Healthcare Needs and

                        ^  to augment the financial support for enhanced Primary Healthcare;

  

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

            *  Promoting at least 729 Community HEALTH Forums throughout our nation

                        that are individually comprised of multiple counties or parts of a county

                        to encompass, on average 400,000 resident persons, as the basis

                        to form a collective action strategy for defining a Community HEALTH Plan 

                        that will assure that equitably available and ecologically accessible

                        Primary Healthcare is offered to each of their resident persons as the basis

                        to begin reducing the annual health spending for our nation’s healthcare

                        as a portion of our nation’s economy (GDP) by 5% within 5 years and

                        27% within 10 years and

            *  Supporting the HEALTH  SECURITY certification of Primary Healthcare clinics, 

                        community by community, that will achieve justly efficient and

                        reliably effective healthcare for each of a Forum’s resident persons 

                        as measured by a 70% reduction of our nation’s annual maternal mortality ratio

                        within 10 years;   AND  

  

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

            and its PRINCIPLES of Altruism, Trust, Cooperation, Reciprocity, and Excellence by:  

            *  Achieving supportive 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.

     

     

The initial GOALS will reduce the annual health spending for our nation’s healthcare within 10 years by 27% as measured by its portion of the annual gross domestic product.  For example, this would have represented a change from 17.8% in 2018 to 13.0% of our nation’s gross domestic product in 2018, a reduction in 2028 that would have represented an excess of $1.05 Trillion in 2018.  Remember, the faster our economic growth occurs between 2018 and 2028, the actual reduction in absolute health spending as a portion of our national economy would be less than the estimate for 2018 within the 2028 GDP.  In fact, it is likely that a slowing in the annual increase in health spending so that it is less than economic growth will in and of itself support improved economic growth.  From an accounting principle, 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% during 2020, any increase in health spending should be 2.5% or less.  Using current data, it would only take 10 consecutive years to achieve health spending at 13.0% of our national economy.  

                                                   

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 could have improved over 10 years from 42nd worst in 2015 to 11th or better among the 51 advanced/developed nations 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 have still been living in 2019.  The number tends to be ignored, for complex reasons, since there were nearly 4 million births in 2015.  When women die in association with a pregnancy, the social capital lost by their Family is profound, especially for each of these Families with young children.

                                   

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 its high level of maternal mortality is the most important attribute of is underlying paralysis.  It serves as the fundamental problem that supports the implementation of the NATIONAL HEALTH Initiative.  

                                                       

When the initial Meeting of the Board of Trustees occurs, the time clock for NATIONAL HEALTH will start.  During the 2021-22 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 during his Presidential campaign. 

                                                          

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 person’s overall healthcare.  In the absence of enhanced Primary Healthcare, the reduced precision has especially affected our resident persons who have multiple Complex Healthcare Needs and social adversities.  For a national cost of $1.50 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.

                                               

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 may not be soon enough!

                                                                       

                                                                                 

                                                                                       

future  GOALS

                 

The Congressional Charter would not define any future GOALS for the distant affairs of NATIONAL HEALTH.  The Congressional Charter would only eliminate any long-term involvement with the economic support of any person’s healthcare.  The importance of NATIONAL HEALTH for our nation’s healthcare lies in its precisely defined reduction of the conflicts-of-interest that promotes a deficient commitment to the humanitarian mandate as compared to the scientific mandate for our nation’s healthcare.  Currently, the institutions that pay for our nation’s healthcare also largely 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 of determining the minimum standards applicable to any definition of the healthcare eligible for the economic support of each citizen’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 begin to be 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 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 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 influenza pandemic or a catastrophic earthquake along the oceanic coast of Washington, Oregon, and California. 

            *  Focus the affairs of NATIONAL HEALTH to emphasize equitably available and ecologically accessible health care for each citizen’s Basic Healthcare Needs as a basis for any possible future economic need to ration the healthcare for Complex Health Needs based on an ethical standard of 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 a worldwide perspective regarding the Knowledge, Resources, and Human Dignity applicable to each resident person’s HEALTH.

                                                                       

                                                                                              

DISCUSSION

  

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 a broadly supported authority to responsively reconcile the proposals formulated by this combination of public and private institutions.