NATIONAL HEALTH usa

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.