a new era
initial GOVERNANCE
GETTING STARTED
INTRODUCTION
“Let us have faith that right makes might
and in that faith let us, to the end,
dare to do our duty as we understand it.”
Abraham Lincoln (1809 – 1865)
To be sure, these words by Abraham Lincoln may be the most perilous proposition ever by a future Presidential candidate, let alone by his status as an undeclared Presidential candidate in 1860. The quotation above concluded a speech given by Abraham Lincoln on February 27, 1860. As an indication of his resolve, the speech he gave at Cooper’s Union in New York City was the basis for his ensuing Presidential campaign. It represented the origins of his most deeply held beliefs about our nation’s Constitution and its founders. Without any intent to minimize the monumental character of President Lincoln and his single-handed resolve to protect and define our nation’s destiny, I propose that President Lincoln’s use of the word ‘duty’ in 1860 be extended from its original reference. The reference to “duty” should represent a contemporary renewal of our nation’s social mandate to honor each resident person’s human dignity. Nearly 160 years later, I propose that his original commitment to define our nation’s social mandate in 1860 should now include a ‘duty’ to promote Stable HEALTH For Each Person. Our contemporary ‘duty’ should be extended to enhance the Survival Commons of each resident person’s community in collaboration with its adjacent communities, nationwide.
For context, I offer an expanded definition of HEALTH. It may be defined as a person’s daily experience of Well-Being during their lifelong survival that is
A. Endowed by the gestational formation of sufficient synergy between the person’s innate temperament and the person’s underlying baseline homeostasis for modulating the person’s initial adaptive resilience immediately after birth and subsequently during early childhood;
B. Nurtured by the person’s caring relationships that originate before birth from within the person’s Family to encourage the person’s search for the broadest portrayal of their sentient reflective-Cognition Cluster of Human Capabilities as a joyful dependent person and originate after birth from within the person’s Family, its Extended Family, and its micro-social networks to mentor the adaptive resilience of the person’s innate temperament during the social interactions occurring while becoming a courageous independent person;
C. Challenged by the person’s daily encounters with modest disruptive processes beginning before birth and occurring as interacting combinations and patterns to cause variably reversible and either beneficent or maleficent effects on the adaptive resilience of the person’s combined innate temperament and sentient reflective-Cognition Cluster of Human Capabilities as ameliorated lifelong by the joyful and courageous caring relationships originating lifelong from within the person’s Family, its Extended Family, and its micro-social networks;
D. Matured by the person’s episodic encounters with substantial disruptive processes beginning before birth and occurring as interacting combinations and patterns to cause variably irreversible and usually maleficent effects on the resilience of the person’s combined Clusters of Human Capabilities and innate temperament as variously prevented, mitigated, and ameliorated lifelong by the Personal Survival Plan of the person; AND
E. Sustained by the person’s hopeful caring relationships, the Family Traditions of the person’s Family, and the Survival Commons of the person’s community until the resilience of the person’s combined Clusters of Human Capabilities and innate temperament becomes insufficient for the person’s survival from their lifelong encounters with disruptive processes.
As a fundamental attribute for promoting the Stable HEALTH of each person, every community of @400,000 citizens will need to sponsor a Community HEALTH Forum. This commitment, based on locally initiated and managed collective action strategies will be required to assure that each person is offered equitably available Primary Healthcare within their own community. Remembering President Lincoln, “… let us, to the end, dare to do our duty as we understand it.”
SEASONED EXPERIENCE FOR GETTING STARTED
At one time or another, almost everyone has been an employee of a very large institution. If you have also worked at the front-line of this institution, you have also been aware that its top leadership occasionally makes decisions that substantially jeopardize the effectiveness and efficiency of your duties. Of course, the outcome of these situations for the front-line employee may be real or just perceived. But, more often than not, these adverse effects of top leadership decisions are real. For the initial Members of the Board of Trustees, I have attempted to define a strategy for selecting nine citizens who would have a wealth of front-line, real-time experience as well as the judgment for guiding the initial GOVERNANCE of NATIONAL HEALTH.
A. One week after the President signs the Congressional authorization of the NATIONAL HEALTH Initiative, the selection process for the initial Members of its Board of Trustees shall begin.
1. Among the State or States within each of 9 Regions, the Governor from the State
with the lowest five-year average for its maternal mortality ratio shall receive
nominations for a Member of the Board of Trustees
[ COMMENT: The use of the maternal mortality ratio (MMR) for rank ordering as a means to select a set of nine States that have been most successful in their commitment to offer available and accessible healthcare for the Basic Healthcare Needs of their resident persons. From 2005 through 2014, the best State within each of the nine Regions had an average MMR of 10.46, and the worst State within each of the nine Regions had an average MMR of 25.40. The most current MMR as reported from our nation’s data reported a MMR of 26.4 during 2015.
Using the World Health Organization report for 2015, the advanced/developed nations of the world in 2015 had an average MMR of 12 and the United States MMR was 14. Poorly understood, the MMR for the United States was 12 in 1990, 1995, and 2000, 13 in 2005, and 14 in 2010 and 2015. (12, 30) In effect, we are the ONLY advanced/developed nation of the world with a worsening MMR since 1990. ]
a. For any Nominee: three personally signed and notarized Statements will be necessary
for their final acceptance as a nominee;
[ COMMENT: The first signed Statement would use a Vesting Format as initially defined by the United States Office of the President. The second signed statement would represent a commitment by the nominee to actively support the affairs of NATIONAL HEALTH as proposed by the initial STRATEGIC PROJECTS PLAN and each of its subsequent revisions. The third signed statement would represent a commitment to arrive in time for a full day of preliminary orientation before the Friday of the initial MEETING. The orientation would involve the preparation by each Member of their own Career Achievement Plan, the status of current healthcare reform, defining a unified epistemology for the core concepts of HEALTH and healthcare reform, and the Design Principles associated with a successful strategy to manage a common-pool resource. Nobel Prize Winner in 2009, Professor Elinor Ostrom was an economist whose academic career focused on the characteristics associated with the successful management of a common-pool resource. ]
b. For the state responsible for a Primary Physician nominee (3) –
i. one by the Primary Physician who is the highest Officer
within the Medical School of a Region demonstrating the
highest percentage of its Resident’s finishing three years of
training as a Primary Physician given the total number of
residents finishing three contiguous years of any residency track
during the previous 3 years,
ii. one by the top Primary Physician officer of the Public Health Department
within the largest city within a Region, AND
iii. any willing Primary Physician in practice for more than 30 years
who had served a single community for at least 20 years
within a Region;
c. For the state responsible for a Physician Specialist Nominee (2) –
i. one by the highest-ranking medical specialist officer from the
Medical School with the highest average number of enrolled medical
students for 5 years within a Region and located in a metropolitan area
with no other medical school within 50 miles,
ii. one by the specialist physician, highest-ranking officer
of a Community-wide AMA affiliated society with the most members
within a Region, AND
iii. any willing physician in practice within one specialty for 30 years or more
and located in one community within a Region for 20 years or more;
d. For the state responsible for a non-physician, public health Nominee (1) –
i. one by the State Public Health Director for the Region’s state with the
lowest five-year average motor vehicle mortality rate,
ii. one by the Dean, School of Public Health from the University
of a Region’s state or states having the best, most recent childhood
immunization rate through 6 years of age, and
iii. any willing Director of a City or County Health Department
of a State or States within a Region for at least 15 years;
e. For the state responsible for a non-physician, mental health Nominee (1)
with experience specified by the Initiative –
i. one by any Governor from the State or States within a Region and
ii. one by the Chief Executive Officer from the Region’s
General Hospital with the most patients
discharged during the last calendar year
from a dedicated Psychiatric unit, AND
f. For the state responsible for a non-physician general Nominee (2)
with experience specified by the Initiative,
i. one by any Governor from the State or States within a Region and
ii. one by the Mayor from the largest city within the lowest populated County
of each State or States within a Region;
2. Within 30 days of finalizing the authorizing legislation, the State Governor for each Region
shall interview at least three of the prospective nominees to select a
Member for the initial Meeting of the Board of Trustees according to the sequential outline
described below. This outline also specifies the term of initial appointment.
Within another 10 days, the final selection by each Governor shall be delivered
to the President, or designee, and to each nominee. Within another 30 days,
the President, or designee, shall convene the initial Meeting of the
Board of Trustees. The President, or designee, shall schedule the initial Meeting
on the Second Friday of the applicable month and preside at this Meeting
until the first Chairman and Vice-Chairman are selected.
[ COMMENT: The Regions are numbered based on the average of the year that the State or States in each Region were admitted to statehood. The lowest and highest State maternal mortality ranking among all 50 states is indicated along with the Regional average, “A.” Finally, the Regional groupings were ranked 1-9 based on their final average state ranking. (30) ]
a. Region 1 East: Primary Physician Member, 1 year (length), yes (reappointment),
MMR range: Delaware 21st – New Jersey 50th; “A” of 35th; Regional 7th of 9
b. Region 2 North East: Public Health Member, 2 years, yes
MMR range Massachusetts 1st – New York 35th; “A” of 14th; Regional 2nd of 9
c. Region 3 South East: Specialist Physician Member, 3 years, yes
MMR range West Virginia 11th – Georgia 48th; “A” of 27th; Regional 5th of 9
d. Region 4 Central: Non-physician Member, 4 years, no
MMR range Kentucky 20th – Missouri 39th; “A” of 30th; Regional 5th of 9
e. Region 5 South Central: Primary Physician Member, 5 years, no
MMR range Alabama 9th – Mississippi 45th; “A” of 36th; Regional 8th of 9
f. Region 6 North Central: Mental Health Member, 6 years, no
MMR range Minnesota 9th – Michigan 42nd; “A” of 22; Regional 3.5 of 9 (tied)
g. Region 7 West: Specialist Physician Member, 7 years, no
MMR range California 5th – (same ); “A” of 5th; Regional 1st of 9
h. Region 8 South West: Non-physician Member, 8 years, no
MMR range Arizona 19th – Oklahoma 47th; “A” of 38th; Regional 8th of 9
i. Region 9 North West: Primary Physician Member, 9 years, no
MMR range Alaska 2nd – Wyoming 38th; “A” of 22nd; Regional 3.5 of 9 (tied)
3. Beginning with the fourth, full year after the initial MEETING of the Board of Trustees,
each new Member of the Board of Trustees shall be selected by the Regional Councils
in the order and skills as identified above. Before each new subsequent 9-year selection
process, the Board of Trustees shall revise the State accessibility ranking based
on the most recent applicable Operational Statement of the Board of Directors.
This ranking shall determine the State of each Region whose Governor shall
select the Members of the respective Regional Council. AND
4. The initial Member term is specified above. Beginning with the fourth year, the terms are
nine years. A replacement appointment may be selected in the usual manner
to complete a Member’s appointment.
B. “Regional Councils” shall be defined according to the State groupings listed on the Initiative Sub-Page ORGANIZE SYSTEMS. The State or groupings of States for the Regional Councils would have represented a mean population of 36,300,000 using the 2016 population census estimated by the US Census Bureau. The population totals of the Regional groupings vary from one Region to another Region by one standard deviation of 2.45 that represents 6.8% of the mean population among the 9 Regions. A proposed selection for the Home Office locations of the Regional Councils and District Coalitions is defined below.
[ COMMENT: The Home Office location for the Board of Trustees is defined on the ORGANIZE SYSTEMS SubPage. It is Saint Louis, Missouri. The basis for Home Office selection processes is defined on that Sub-Page. ]
1. Region 1 (32.74) East: (Baltimore, Maryland)
a. Districts 1-4 (Philadelphia, Pittsburgh, Harrisburg, Scranton): Pennsylvania (12.78)
b. Districts 5-6 (Atlantic City, Newark): New Jersey (8.94)
c. Districts 7-8 (Hagerstown, Annapolis): Maryland (6.02), Delaware (0.95)
d. District 9 (Washington, D.C.): District of Columbia (0.68), Protectorates of
Puerto Rico (3.20) and U.S. Virgin Islands (0.17) ;
2. Region 2 (34.47) North East: (Hartford, Connecticut)
a. Districts 1-5 (New York City 2, Long Island 1, Syracuse 1, Rochester 1):
New York (19.74)
b. District 6 (New Haven): Connecticut (3.58)
c. Districts 7-8 (Boston, Springfield): Massachusetts (6.81), Rhode Island (1.06)
d. District 9 (Hanover): New Hampshire (1.33), Vermont (0.62), Maine (1.33) ;
3. Region 3 (35.66) South East: (Raleigh, North Carolina)
a. Districts 1-2 (Winston-Salem, Wilmington): North Carolina (10.15)
b. District 3 (Columbia): South Carolina (4.96)
c. Districts 4-6 (Atlanta, Augusta, Alexandria): Georgia (10.31)
d. Districts 7-9 (Charleston, Richmond, Alexandria): Virginia (8.41)
West Virginia (1.83) ;
4. Region 4 (35.42) Central: (Cincinnati, Ohio)
a. District 1 (Jefferson City): Missouri (6.09)
b. Districts 2-4 (Cincinnati, Columbus, Cleveland): Ohio (11.61)
c. Districts 5-7 (Bowling Green, Louisville, Fort Wayne): Indiana (6.63)
Kentucky (4.44)
d. Districts 8-9 (Nashville, Memphis): Tennessee (6.65);
5. Region 5 (36.13) South Central: (Montgomery, Alabama)
a. Districts 1-5 (Pensacola, Tallahassee, Jacksonville, Tampa, Miami): Florida (20.61)
b. District 6 (Little Rock): Arkansas (2.99)
c. District 7 (Baton Rouge): Louisiana (4.68)
d. District 8 (Jackson): Mississippi (2.99)
e. District 9 (Birmingham): Alabama (4.86) ;
6. Region 6 (37.16) North Central: (Madison, Wisconsin)
a. Districts 1-3 (Chicago 2, Springfield): Illinois (12.80)
b. Districts 4-5 (Milwaukee, Eau Claire): Wisconsin (5.78)
c. District 6 (St. Paul): Minnesota (5.52)
d. District 7 (Des Moines): Iowa (3.13)
e. Districts 8-9 (Ann Arbor, Grand Rapids): Michigan (9. 93) ;
7. Region 7 (39.25) West: (Sacramento, California)
a. Districts 1-9 (Los Angeles 3, San Francisco 2, Santa Rosa,
Redding, San Diego, Bakersfield) ;
8. Region 8 (40.79) South West: (Austin, Texas):
a. Districts 1-5 (Dallas, Houston, San Antonio, Lubbock, El Paso): Texas (27.86)
b. District 6 (Oklahoma City): Oklahoma (3.92)
c. District 7 (Albuquerque): New Mexico (2.08)
d. Districts 8-9 (Phoenix and Tucson): Arizona (6.93) ; AND
9. Region 9 (35.20) North West: (Salt Lake City, Utah)
a. District 1 (Lincoln): Kansas (2.91), Nebraska (1.91)
b. District 2 (Cheyenne): South Dakota (0.86), North Dakota (0.76),
Montana (1.04), Wyoming (0.58), Idaho (1.68)
c. District 3 (Reno): Nevada (2.94)
d. District 4 (Denver): Colorado (5.54)
e. District 5 (Salt Lake City): Utah (2.85)
f. District 6 (Portland): Oregon (4.09)
g. Districts 7-8 (Seattle and Spokane): Washington (7.27)
h. District 9 (Honolulu): Alaska (0.74), Hawaii (1.43),
Protectorates of American Samoa, Federated States
of Micronesia, Guam, Marshall Islands, Northern
Mariana Islands, and Palau (0.60) .
C. The Members of each Regional Council and District Coalition shall be chosen according to an Operational Statement authorized by the Board of Trustees within one year after the initial Meeting of the Board of Trustees.
D. The administrative Associates AND the Members for the Board of Trustees, Regional Councils, and District Coalitions shall be selected and supervised by the Chairman, or designee, of the Board Trustees. The Home Office and the Office for each of the Regional Councils shall have responsibility for a core Task of NATIONAL HEALTH as determined by the Board of Trustees, such as:
1. Home Office: Annual Report, Governmental liaison, Operational Statements
2. Regional Council TBA: Finance, Information System, External audits
3. Regional Council TBA: Human Resources, Crisis Intervention Team, Internal Training
4. Regional Council TBA: HEALTH SECURITY Certification development
5. Regional Council TBA: PRIMARY HEALTHCARE BENEFITS PLAN management
6. Regional Council TBA: PRIMARY PHYSICIAN EDUCATION PLAN management
7. Regional Council TBA: Security, Internal Audit, Risk Management
8. Regional Council TBA: Planning, Grants Management, Internal Research
9. Regional Council TBA: Public Relations, Definition of Non-covered BENEFITS
10. Regional Council TBA: “Community HEALTH Forum” development