NATIONAL HEALTH

 

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 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 Advocates for each 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 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  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 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  as focused by its associated set of  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.’

                     

enhanced   PRIMARY  HEALTHCARE

                    

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 rely on broadly encouraged norms of Trust, Cooperation and Reciprocity 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  and  ecologically accessible  by every citizen within their own 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,  Trust,  Cooperation,  Reciprocity  and  Excellence.   Beginning with Primary Healthcare, promoting ‘enlightened competition’ would secondarily refocus the character of health care offered 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 release 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 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 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.

                                                               

                                                                                                 

initial  GOALS

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

 

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

           *  Maintaining a  PRIMARY HEALTHCARE  BENEFITS  PLAN  as a set

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

                       of a citizen’s Basic Healthcare Needs from any payment or other economic source within 4 years,

           *  Coordinating an evolving statement for a  PRIMARY PHYSICIAN  EDUCATION  PLAN 

                       by our nation’s medical schools beginning with the first year of medical school

                       as a basis to assure the uniform availability of   Primary Physicians

                       with the career-long adaptability to acquire the skills required for the

                       PRIMARY HEALTHCARE  BENEFITS  PLAN,  and

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

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

                                   its coordination with any Complex Healthcare Needs   and

                       ^  to augment the financial support for enhanced 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 a  collective action  strategy 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 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, 

                       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 annual maternal mortality ratio within  10  years;      AND  

  

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

           and its   V A L U E S   of   Altruism,   Trust,   Cooperation,   Reciprocity   and   Excellence   by:  

           *  Achieving 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  17.9%  in 2018 to  13.1%  of our nation’s gross domestic product in 2028,  a reduction in 2028 that would have represented an excess of  $1.01  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 of health spending so that is less than economic growth will in and of itself improve the economic growth.

                                                   

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 have still be living in 2016.  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 to a  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 it high level of maternal mortality is the most important attribute of is underlying paralysis.  

                                                       

When the  initial Meeting  of the Board of Trustees occurs, the time clock for  NATIONAL HEALTH  will start.  During the 2019 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”  (aka mass shootings) 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 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  $1.50  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 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 each community.  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 locally 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 each citizen’s Basic Healthcare Needs as a basis for any possible future economic need to ration the healthcare for Complex Health Needs;

                        AND

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

                                                                       

                                                                                              

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 reconcile the proposals formulated by this combination of institutions.