NATIONAL HEALTH usa

   enlightened  competition

 

   

       

            

 G  O  A  L  s 

   

   

     

    

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 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 the author of this poem. Several other authors published similar versions during the 19th century. The Emerson version still resonates best with its special presence for defining the successful pursuit of each person’s life. This presence would be a worthy attribute for the involvement of anyone, such as a Community Advocate, who is 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 personal priorities of each healthcare provider, unexpectedly and 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 revise the special priorities of their obligations. These continually reassessed priorities would then promote a commitment *) to eliminate any awareness or motive of unbalanced competition during the decision process that occurs for 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 should 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 during each person’s 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 health care encounter. Redirecting our nation’s healthcare traditions to improve the alignment of these 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 competition.’ 

          

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 collaborative strategy would rely on the PRINCIPLES of Altruism, Trust, Cooperation, Reciprocity, and Excellence to promote the Global Institutional Tasks applicable for assuring the equitable availability and ethnographical accessibility of enhanced Primary Healthcare, community by community. To benefit from these Operational Statements, the NATIONAL HEALTH Proposal would specifically prompt the formation of local efforts to assure that enhanced Primary Healthcare steadily becomes equitably available for each resident person within their own community. This new strategy would focus on the locally prominent stakeholders to join a collaborative process for resolving the neighborhood inequities underlying the availability and accessibility of their own 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 of any encounter for the health care of Basic Healthcare Needs. Slowly but surely, enhanced Primary Health Care would be refocused by its connection with NATIONAL HEALTH. Beginning with Primary Healthcare, promoting ‘enlightened competition’ would secondarily refocus the character of this health care to continuously curate a comprehensive Care-Plan that integrates a person’s Basic Healthcare with any Complex Healthcare concurrently being offered to each resident person.

   With Primary Healthcare at the leading edge of its paradigm shift, ‘enlightened competition’ 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, especially its equitable availability as well as its ecological and cultural accessibility within every community.

   To resolve the current paradigm paralysis afflicting our nation’s healthcare, a high level of ‘enlightened competition’ as an attribute of enhanced Primary Healthcare could produce the day-to-day synergy necessary for steady change. Within fifteen years, unlocking the paradigm paralysis affecting our nation’s Population Health and its 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 Healthcare Team Member who supports the new strategy of the NATIONAL HEALTH Proposal, a commitment to ‘enlightened competition’ will be their pathway to an inner presence of “Success” as described by Ralph Waldo Emerson. 

       

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 nearly equal

                        citizen populations of approximately 36 million citizens;

            B. Establish a Board of Trustees with nine members, each member eventually selected periodically

                        by their respective Region’s Advisory Board on a 9-year rotating process that is based on a Plan

                        to achieve a balanced representation of the Members that represent the applicable

                        Population Health, Social, and Scientific Stakeholders;

            C. Establish nine Regional offices, each associated with its own nearly equal population 

                        to be established in accord with the Plan for the Board of Trustees to assume the

                        responsibilities assigned to each Regional office by the Board of Trustees for     

                        the overall governance of  NATIONAL  HEALTH, advice and consent 

                        for the establishment of Operational Statements, and the promotion of approximately 

                        90 communityHEALTHforums in their Region; 

            D. Locate the Home Office of  NATI0NAL  HEALTH  near the geographic population center

                        of the continental USA including Hawaii and Alaska, viz., Saint Louis;

            E. Fund its annual affairs with $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 may only be allocated to the expenses authorized by the Board of Trustees,

                        its Regional Advisory Boards, or for a “rainy day fund;” 

            F. Avoid any involvement with the direct financial distribution of economic healthcare reimbursement

                        or the operational funding of any communityHEALTHforum;   

            G. Maintain and periodically revise a Design Epistemology to guide any future reconfiguration

                        of our nation’s Population Health or its healthcare; and 

            G. Achieve its GOALS steadily without major internal distraction or risk a 2-Stage Sunset notification

                        by the President, by either a 6-month termination notice or a 2-year provisional termination notice. 

   

    

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

 

I. Establish four  NATIONAL  PROJECTS within 3 years for improving the 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, 

 

            B. Coordinating an evolving statement for a  PRIMARY PHYSICIAN EDUCATION PLAN

                        within each of our nation’s Regional medical schools as a general format for the undergraduate and 

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

                        of Primary Physicians who individually accept a personal responsibility to pursue

                        their career’s professional renewal by continuously acquiring the adaptive skills

                        as prompted by the PRIMARY HEALTHCARE  BENEFITS PLAN;

   

            C. Establishing HEALTH SECURITY certification 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 a deeply-nested, monitoring system

                        to assess the stop-loss protected, financial performance of all payers and

                        providers of healthcare that recognizes national health spending

                        as a Common Pool Resource of Medicare;

 

      

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 parts of a 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 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 16% and

                        27% within 15 years as in 18% to 13%;

 

            B. Resolving the generational, locally driven, ecologic and cultural traditions that

                        adversely impact the resident persons of every community by including

                        within each communityHEALTHforum’s, Community HEALTH Plan

                        1. a Master Disaster Preparedness Plan that assures a connection with adjacent

                                    communities along with their State and Federal preparedness plans;

                        2. an assessment of the community’s Survival Commons (aka enhanced 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 baseline community measurement tool for assessing changes 

                                    in the level of Social Capital within a Forum’s community; AND

    

            C. Supporting the HEALTH SECURITY certification of Primary Healthcare clinics, community by community,

                        that will achieve justly efficient and predictably effective healthcare for the resident persons of every Forum

                        as measured collectively by a 70% reduction of our nation’s annual maternal mortality ratio within 15 years;

         

             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 Community HEALTH Forums 

                        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 16%  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, 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 would be less than the estimate given for 2019 by the year of 2034.

   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 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% for 2019, any increase in annual health spending should be 2.5% or less. By assuming that health spending growth was 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, the total cost of the Iraqi-Afghanistan War in 2005 was $100 Billion. Reducing our nation’s health spending in 2019 by $1 Trillion would have represented the equivalent of fighting 10 Iraqi-Afghanistan Wars simultaneously during 2005!

   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 its underlying paralysis. It represents our nation’s 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 predictable 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 as well as social adversities. For a Federal fixed-cost of $1.50 per resident person annually,  NATIONAL HEALTH  would establish a precisely coordinated reform of our nation’s Population Health traditions, especially each community’s social adversities. 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 one of every twenty 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 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 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 a 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. 

 

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. However, there currently is no nationally sanctioned institution with community connections and trustworthy traditions that could responsively reconcile the proposals formulated by this combination of public and private institutions.