S o c i a l C o h e s i o n
G O A L s
10 pages — 1 —
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)
^
“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)
INTRODUCTION
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. 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 by Senator Robert Kennedy during his Presidential campaign in 1968.
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 spectral priorities of their obligations. These continually reassessed priorities would then promote a commitment *) to eliminate any awareness or motive of unbalanced competition during the cognitive reasoning that occurs during each health care encounter and *) to carefully self-examine the relevant, apparent or real, conflicts of interest: be they moral, professional, 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 for 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 a health care 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, patient acceptance, social interaction spontaneity, relevant documentation, resource allocation, as well as its 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.’
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. This New Strategy would rely on the PRINCIPLES of Altruism, Trust, Cooperation, Reciprocity, and Excellence to promote the Global Institutional Tasks applicable for assuring the availability and accessibility to enhanced Primary Healthcare by each community’s resident person. 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 collaborative process for resolving the neighborhood inequities associated with the availability and accessibility of their own community’s 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 sociality 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 Family Traditions within any Complex Healthcare required by a resident person.
With Primary Healthcare at the leading edge of its paradigm reform, ‘enlightened reasoning’ would become an essential attribute for reconfiguring our nation’s 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 health care 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, and 3) the deficient financial resources currently available to achieve 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 sociality will be their pathway to an inner presence of “Success” as described by Ralph Waldo Emerson. — 3 —
– – – – – – initial GOALs – – – – – –
A Congressional Charter would define the initial GOALs for NATIONAL HEALTH and its fundamental governance.
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 population of citizens;
B. Establish a Board of Trustees with nine Members, each eventually selected periodically
by their respective Region’s Advisory Board 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, Social, and Scientific Stakeholders;
C. Establish nine Regional offices, each representing its own nearly equal portion of national citizens
in accord with the Plan for the Board of Trustees, *) for the responsibilities assigned
to each Regional office by the Board of Trustees for the operational governance
of NATIONAL HEALTH, *) for advice and consent regarding the preparation
of Operational Statements, and *) for offering technical support to approximately
90 communityHEALTHforums within in their Region;
D. Locate the Home Office of NATI0NAL 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 initial Meeting of the Board of Trustees that shall only be allocated
*) to the expenses authorized by the Board of Trustees for itself or its Regional Councils, or
*) a NATIONAL HEALTH “rainy day fund;”
F. Avoid any operational associated involvement with *) the direct financial distribution
of economic reimbursement for any resident person’s health care or healthcare or
*) the operational funding of any CommunityHEALTHforum;
G. Maintain and periodically revise a Design Epistemology to guide any future reconfiguration plan
for our nation’s Population Health or its healthcare; and
H. Achieve its GOALs steadily without major internal distractions or risk a 2-Stage Sunset notification
by the President for either *) a 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 improving the Primary Healthcare offered
to each community’s resident persons by:
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 PHYSICIAN 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 pursue their career’s professional development by continuously acquiring
the adaptive skills associated with the PRIMARY HEALTHCARE BENEFITS PLAN;
C. Establishing a HEALTH SECURITY CERTIFICATION PLAN for the clinics offering
enhanced Primary Healthcare as the basis
1. to improve each person’s health care for their Basic Healthcare Needs including
its coordination with any Complex Healthcare Needs and
2. to apply their clinic’s augmented financial support to offer broadly
enhanced Primary Healthcare; AND
D. Establishing a national FINANCIAL RISK-MANAGEMENT PLAN for health spending
with a deeply-nested, monitoring system to assess the stop-loss protected, financial performance of all
providers of healthcare that recognizes national health spending as a Common Pool Resource and
involving 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 by
A. Promoting at least 810 CommunityHEALTHforums 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 CommunityHEALTHplan to assure that
equitably available as well as ecologically and culturally accessible,
enhanced 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, as in 18% to 17%, and by 27% within 15 years as in 18% to 13%;
B. Resolving the uniquely generational, locally driven, ecologic, and cultural traditions that
adversely impact certain resident persons within every community by including
within each CommunityHEALTHforum’s, CommunityHEALTHplan
1. a Master Disaster Preparedness Plan that assures a connection with its contiguously
adjacent communities and their State and Federal preparedness plans;
2. an assessment of the community’s Survival Commons (aka safety net),
especially any deficits applicable to neighborhood safety or nutritional access,
affordable and code-enforced housing, early childhood education,
homelessness prevention, as well as employment entry; and
3. 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 social networks from within their mutually relevant communities
associated with Human Dignity by the Board of Trustees, each Regional Council, and
each CommunityHEALTHforum to enhance our nation’s Social Cohesion as measured
by a steady decline in the number of chronically homeless persons. — 5 —
AND
III. Achieve widespread, broadly based national support for the affairs of NATIONAL HEALTH
and its PRINCIPLES of Altruism, Trust, Cooperation, Reciprocity, and Excellence by:
A. Achieving supportive ratification of its Congressional Charter by 30 states within 5 years,
B. Recognizing the officially operating existence of 500 CommunityHEALTHforums
within 5 years, and
C. 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 as a portion of our national economy within 5 years by 5% (viz., 18.0% in 2019 to 17% in 2024) and within 15 years by 27% (from 18.0% in 2019 to 13.0% in 2034) as measured by the portion of the annual gross domestic product that represents health spending. For example, the difference between our nation’s health spending of 18.0% and 13.0% of our nation’s gross domestic product (GDP) for 2019 alone would have represented $1 Trillion. Remember also, the faster our economic growth occurs between 2019 and 2034, the actual reduction in absolute health spending as a portion of our nation’s GDP could be unchanged.
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 health spending.
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 of the 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 capital lost by their Family is profound, especially for each of these Families who already have children.
To rank among the 14 nations with the best maternal mortality ratio in 2018 (Australia, Finland, Ireland, Italy, Sweden, Netherlands, Spain, Germany, Switzerland, Denmark, Norway, Canada, United Kingdom, and New Zealand), the number of maternal deaths in 2018 for our nation’s women would have been less than 300. To understand the implications on the overall HEALTH within a Family by a maternal death, see the RATIONALE Sub-Page for a contemporary (viz., Anthropocene) Definition of HEALTH. The fundamental 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 the underlying cognitive dissonance. It represents the most fundamental HEALTH problem that defines the emergent immediacy for implementing the NATIONAL HEALTH Proposal.
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.
Improving the equitable availability, ecologic and 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 each resident person’s Population HEALTH as well as its 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 of 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. — 7 —
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.
The NATIONAL HEALTH Proposal creates an opportunity to foster a national dialogue as a basis for planning any overall decision structure applicable to another serious pandemic or another disaster overwhelming our nation’s healthcare resources, be it regional or national. With Congressional authorization of NATIONAL HEALTH and its 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 our nation’s HEALTH. Specifically, this sponsorship would foster an evolving, justly efficient model for managing regional or national Healthcare Disaster prevention, mitigation, and amelioration at the community level. In effect, the ultimate benefit of NATIONAL HEALTH for our nation’s healthcare would be its existence as an institution with a widely accepted, trustworthy reputation. Importantly, this trustworthy capability would be most important for reconciling *) the vested interests of the scientific mandate to pay for our nation’s healthcare with *) the vested interests of a humanitarian mandate to arrange the greatest good for the greatest number of resident persons, community by community.
JUSTLY EFFICIENT
Given the economic traditions of our nation’s healthcare, it may ultimately be too difficult – or even unnecessary – to eventually implement a new basis for the reimbursement of any person’s Complex Healthcare Needs, if any. The initial degree of widespread acceptance and support for the description of minimum Healthcare Benefits just for Basic Healthcare Needs may be the best predictor of any future effort that could be applied to Complex Healthcare Needs. The NATIONAL HEALTH sponsored dialogue for establishing the minimum definitions for a national Certificate of Benefits applicable to Primary Healthcare will involve various compromises among the legitimate vested interests including a provision to allow State by State definitions for certain specific Benefits, such as fertility and the special newborn detection of congenital metabolic disorders. Hopefully, a national Certificate of Benefits would also achieve a level of resident person trust that any, apparent or real, future level of rationing would be applicable to every resident person, especially in the event of a national or regional disaster. To achieve this level of support, a high level of Trust, Cooperation, and Reciprocity that is intentionally sustained would establish the widespread acceptance of NATIONAL HEALTH and its Board of Trustees, nine Regional Councils, and its 810 CommunityHEALTHforums.
The formal governance for NATIONAL HEALTH would promote a CommunityHEALTHforum for each of at least 810 communities, each focused on the Stable HEALTH of their own resident persons. Established through local initiative, each CommunityHEALTHforum would sponsor the collective action strategies, community by community, applicable to assure that enhanced Primary Healthcare is at least equitably available to and both ecologically and culturally accessible by each resident person within their own community. I propose that a widespread interaction by each Forum with the Forums of their respectively, adjacent communities could also be the best means to assure that any national disaster plan involving our nation’s Population Health reconciles the national and regional needs with its locally applicable implementation. This level of collaboration may be an important outcome to improve our nation’s declining social cohesion.
The academic studies that formed the basis for “Governing the Commons” by Professor Elinor Ostrom (2005) are especially applicable to the shared use problems related to our nation’s healthcare. It is highly unlikely that the Accountable Care Act of 2010 will achieve a sufficiently efficient healthcare industry for resolving its evolving “Tragedy of the Commons.” NOW is the time to apply the collective action solutions defined by Professor Ostrom. A Nobel Prize awardee in 2009, she died in May of 2012. Her award represented the first woman selected as a Nobel awardee in Economics (the second occurred 10 years later in 2019). In her honor, I propose a personal intent for this NATIONAL HEALTH Proposal. The initial Meeting of the Board of Trustees should occur in May of the year.
CONTINUOUS REFORM
With a Congressionally fixed, population-based, and COL-adjusted budget, the possibility of a progressively intrusive involvement in the day-to-day affairs of each resident person’s health care by a Federalized health system would be prevented. Given a progressive improvement in the health spending ‘for’ and the quality ‘of’ our nation’s healthcare, what then would be the eventual role of NATIONAL HEALTH for our nation’s Population Health and its Primary Healthcare? The level of uncertainty given the future turmoil throughout our world is profound. The worldwide community and the marketplace arenas for its Resources, Knowledge, and Human Dignity are at stake. We must never again allow the healthcare industry to jeopardize our nation’s autonomy within the world’s marketplace arena for its Resources. Very likely, a constant and continuously adjusted long-term plan for healthcare reform will always be necessary for our nation. This view of permanent adaptation may be most clearly recognized by the words of President Thomas Jefferson, most widely accessible by their reproduction within his memorial at the Tidal Basin in Washington, D.C. [ see the EPILOGUE Sub-Page ].
Continuously sponsored, healthcare reform will be necessary to achieve Stable HEALTH for each Resident Person. This improvement 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% for this age group. With the improvement of the social capital asset of each community by their CommunityHEALTHForum, I propose a goal of reducing this mortality rate to 20% of all deaths within this age group. The presence of 810 CommunityHEALTHforums could have a sentinel benefit for a further reduction to 17%. A reduction in the level of violence, as an attribute of our nation’s POPULATION HEALTH, would represent a broad measure of nationally improved social cohesion from the affairs of NATIONAL HEALTH. This community-based focus for healthcare reform may be our most valuable national asset as we re-focus our nation’s autonomy within the world’s marketplace arenas for its Resources, Knowledge, and Human Dignity. In effect, the future heritage of our nation’s autonomy within the worldwide community is at stake.
ROSA PARKS and MAYA ANGELOU
Are we not really just lost in our nation’s cultural and ecologic adaptation to the rapidly evolving world order of the ANTHROPOCENE since WWII? The authenticity of these two authors should indelibly remind us about our fundamental duty to care for and about each other. Now, return to the 2nd page above and read again their admonitions to us all!
S U B P A G E S
supportive GOALS The initial function of NATIONAL HEALTH would focus on the two-fold importance of 1) enhanced Primary Healthcare for the promotion of a precisely focused healthcare industry characterized by a high level of efficiency, accessibility, efficiency, and effectiveness and 2) a national, community by community, strategy to improve its social cohesion deficits. When the initial benefits of this combined strategy begin to demonstrate success, there are several other attributes of our nation’s HEALTH and its healthcare that may demonstrate a need for newly prioritized, community-driven attention. This Sub-Page offers a discussion of the long-term needs underlying our nation’s Population Health that may potentially benefit from the focused, analytic experience of a semi-autonomous NATIONAL HEALTH institution.
GENERAL OPERATING PRINCIPLES Promoting a responsive and inclusive focus on the affairs of NATIONAL HEALTH will be difficult. Meaningful healthcare reform will need a national level of goodwill and commitment probably not witnessed since WWII. To sustain this level of goodwill 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. The structural format of this OPERATIONAL STATEMENT establishes a clearly defined, derivative structure as the basis to establish the governance dimensions required for NATIONAL HEALTH to improve our nation’s Population HEALTH as well as its HEALTHCARE. — 9 —
initial GOVERNANCE Of essential importance for the initial Meeting of the Board of Trustees, the governance of NATIONAL HEALTH should represent a carefully structured basis for defining its derivative levels of responsibility and accountability. 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 would eventually merge into the permanent process as defined by the Congressional Charter. This Sub-Page describes a proposal for an expedient selection of Members for the initial Meeting of the Board of Trustees.
STRATEGIC PROJECTS PLAN The GENERAL OPERATING PRINCIPLES Policy would require several Procedures to implement its intent. The most important of these is this Procedure with its broad plan for achieving the GOALs of NATIONAL HEALTH. This Sub-Page represents an OPERATIONAL STATEMENT for defining an optimal starting point for implementing the affairs of NATIONAL HEALTH.
HEALTH SECURITY CERTIFICATION PLAN It is likely that the criteria and process of certification for enhanced Primary Healthcare will require a special effort to promote change through a carefully defined process. Given access to enhanced reimbursement for a certified Primary Healthcare facility, this evaluation process will require a nationally conceived consensus. The institutional format for this process will probably evolve in conjunction with the evolving affairs of NATIONAL HEALTH. The process is defined initially to require a set of minimum requirements and a clinic’s steady improvement toward achieving the ultimate level of compliance within three years. The analysis of this clinic-by-clinic progress will be publicly reported for any ‘resident person’s comment” by each District Coalition.
COMMENT The HEALTH SECURITY certification will require each clinic to offer licensed RN personnel as the clinic’s telephone ‘initial responder’ for medical TRIAGE assistance. Promoting this level of trustworthy responsiveness by each Primary Healthcare clinic will, within 18-24 months, reduce this clinic’s hospital utilization rates by 10-15%. This reduction of hospital utilization could achieve a 25-30% decrease by a “capitated, risk-sharing, and referral-preauthorization” controlled, insurance model. Remember, Trust and Self-Reported Well-Being have been verified by population studies to exhibit reverse causality.
This page has the following sub pages.