NATIONAL HEALTH usa

Improving our nation's POPULATION HEALTH and its PRIMARY HEALTHCARE, "All Together"

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* Initiating GOVERNANCE

a  new era

 

 

 

 

 

 

 

 

 

i n i t i a l     G O V E R N A N C E

 

First  Meeting  of  the  Board  of  Trustees

 

 

 

 

 

 

 

 

2.8

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 cited 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 Constitutional 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 for  HEALTH.  It may be postulated as a person’s daily experience of lifelong Well-Being that occurs when the resilience of the person’s survival has been

  

A. Endowed initially  by the maternal, Family Traditions existing before conception and subsequently by the gestational formation of synergy between the person’s innate temperament and the person’s baseline homeostasis to achieve adequate resilience for the person’s continuing survival immediately after birth and thereafter by a Personal Survival Plan originating from within their Family;

 

B. Nurtured  by the person’s caring relationships that originate from within the person’s Family, its Family Convoy, and their Home’s close neighborhood  1) during their early childhood development with a goal to enrich the person’s search for the broadest portrayal of their uniquely-endowed Human Capability while becoming a joyful ‘dependent person’ and  2) during their late childhood, adolescent, and early adulthood development with a goal to mentor the person’s simultaneously evolving personality, moral reasoning, and self-esteem for the broadest portrayal of their uniquely endowed Human Capability while becoming a courageous, sustainably self-sufficient ‘independent person’ after adolescence; 

  

C. Challenged  by the person’s daily encounter with disruptive processes involving discordant social interactions that begin before birth, occur as interacting combinations and patterns, and cause variably reversible and either beneficent or maleficent changes to the adaptive resilience of the person’s uniquely-endowed Human Capability, its innate temperament, and its baseline homeostasis as variously prevented, mitigated, and ameliorated lifelong by the joyful caring relationships originating from within the person’s Family, its Family Convoy, and their Home’s close neighborhood;

 

D. Matured  by the person’s episodic encounters with disruptive processes involving diversely traumatic, baseline homeostatic changes that begin before birth, occur as interacting combinations and patterns, and cause variably irreversible and maleficent changes to the adaptive resilience of the person’s uniquely-endowed Human Capability, its innate temperament, and its baseline homeostasis as variously prevented, mitigated, and ameliorated lifelong by the courageous caring relationships originating from within the person’s Family, its Family Convoy, and their Home’s close neighborhood;   AND 

 

E. Sustained  by the hopeful caring relationships originating from within their Family, its Family Traditions, its Family Convoy, their Personal Survival Plan, and the Survival Commons of the person’s community until the continuing resilience of the person’s uniquely-endowed Human Capability is no longer sufficient to maintain the person’s survival as a result of their lifelong encounter 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.

                         

                        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  INITIAL GOVERNANCE  Subpage of the  GOALs  Page.  The State or groupings of States for the Regional Councils would each have represented a mean population of 37,270,000 using the 2020 population census estimated by the US Census Bureau, for a total population of 335,410,000 (including protectorates).  The population totals of the Regional groupings vary from one Region to another Region by one standard deviation of 2.38, representing a 6.4% (6.8% in 2016) of the mean population variation among the 9 Regions.  A proposed selection for the Home Office locations of the Regional Councils and Community HEALTH Forums is defined below.

   

[  COMMENT:  The Home Office location for the Board of Trustees is defined on the  ORGANIZE GOVERNANCE SubPage.  It is Saint Louis, Missouri.  This The basis for Home Office selection processes is defined on that Sub-Page. The population statistics for 2016 were updated in 2021. ]

                 

            1. Region 1  (33.52)  East:  (Baltimore, Maryland)

                        a. Districts 1-5 (Philadelphia, Pittsburgh, Williamsport, Harrisburg, Scranton):  Pennsylvania (13.00)

                        b. Districts 6-7 (Atlantic City, Newark):  New Jersey (9.29)

                        c. Districts 8-9 (Hagerstown, Annapolis):  Maryland (6.018)  and Delaware (0.99)

                        d. District 10 (Washington, D.C.):  District of Columbia (0.69), Protectorates of

                                    Puerto Rico (3.28) and U.S. Virgin Islands (0.09)  Total 1.36   

                                

            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  (20.20)

                        b. District 6 (New Haven):  Connecticut (3.60)

                        c. Districts 7-8 (Boston, Springfield):  Massachusetts (7.03), Rhode Island (1.10)

                        d. District 9 (Hanover):  New Hampshire (1.38), Vermont (0.64), Maine (1.36) ;  

                        

            3. Region 3  (36.69)  South East:  (Raleigh, North Carolina)

                        a. Districts 1-2 (Winston-Salem, Wilmington):  North Carolina (10.44)

                        b. District 3 (Columbia):  South Carolina (5.12)

                        c. Districts 4-6 (Atlanta, Augusta, Alexandria):  Georgia (10.71)

                        d. Districts 7-9 (Charleston, Richmond, Alexandria):  Virginia (8.63)vill

                                   West Virginia (1.79) ;

                    

            4. Region 4  (36.16)  Central:  (Cincinnati, Ohio)

                        a. District 1-2 (Indepedence, St. Louis) :  Missouri (6.15)

                        b. Districts 3-4 (Cincinnati, Cleveland):  Ohio (11.80)

                        c. Districts 5-6 (South Bend, Indianapolis):  Indiana (6.79)

                        d. District 7 (Louisville):  Kentucky (4.51) 

                        e. Districts 8-9 (Nashville, Memphis):  Tennessee (6.91);

                           

            5. Region 5  (37.19)  South Central:  (Montgomery, Alabama)

                        a. Districts 1-5 (Pensacola, Tallahassee, Jacksonville, Tampa, Miami):  Florida (21.54)

                        b. District 6 (Little Rock):  Arkansas (3.01)

                        c. District 7 (Baton Rouge):  Louisiana (4.66)

                        d. District 8 (Jackson):  Mississippi (2.96) 

                        e. District 9-10 (Birmingham, Mobile):  Alabama (5.02) ;

                   

            6. Region 6  (37.68)  North Central:  (Madison, Wisconsin)

                        a. Districts 1-3 (Chicago, Springfield, Rocford):  Illinois (12.81)

                        b. Districts 4-5 (Milwaukee, Eau Claire):  Wisconsin (5.89)

                        c. District 6 (St. Paul):  Minnesota (5.71)

                        d. District 7 (Des Moines):  Iowa (3.19)

                        e. Districts 8-9 (Ann Arbor, Grand Rapids):  Michigan (10.08) ;

                             

            7. Region 7  (39.54)  West:  (Sacramento, California)

                        a. Districts 1-9 (Los Angeles 3, San Francisco 2, Santa Rosa,      

                                    Redding, San Diego, Bakersfield) ;

                       

            8. Region 8  (42.37)  South West:  (Austin, Texas):

                        a. Districts 1-7 (Dallas, Fortworth, Houston, San Antonio, Lubbock, Corpus Christi, El Paso): Texas (29.14)

                        b. District 8 (Oklahoma City): Oklahoma (3.96)

                        c. District 9 (Albuquerque): New Mexico (2.12)

                        d. Districts 10-12 (Flagstaff, Phoenix, Tucson ): Arizona (7.15) ;   AND 

                                 

            9. Region 9  (36.95)  North West:  (Salt Lake City, Utah)

                        a. District 1 (Lincoln):  Kansas (2.94), Nebraska (1.96) 

                        b. District 2 (Cheyenne):  South Dakota (0.89), North Dakota (0.78),

                                    Montana (1.08),  Wyoming (0.58),  Idaho (1.84)

                        c. District 3 (Reno):  Nevada (3.10)

                        d. District 4 (Denver):  Colorado (5.77)

                        e. District 5 (Salt Lake City):  Utah (3.27)

                        f.  District 6 (Portland):  Oregon (4.24)

                        g. Districts 7-8 (Seattle and Spokane):  Washington (7.70)

                        h. District 9 (Honolulu):  Alaska (0.73), Hawaii (1.46),

                                    Protectorates of [American Samoa, Federated States

                                    of Micronesia, Guam, Marshall Islands, Northern

                                    Mariana Islands, and Palau] (0.61); Total 2.80 .

                       

                                  

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

                      

  • Pages

    • 1. HEALTH PROSPECTUS
      • * PREFACE & CONTENTS
      • * DESIGN EPISTEMOLOGY
      • * FIVE HEALTH STORIES
      • * MINDLESS MENACE
    • 2. VINTAGE TRADITIONS
      • * PROLOGUE
      • * LEGAL
      • * MEDICAL
      • * SOCIAL
      • * ECONOMIC
      • * INNOVATION
    • 3. EXECUTIVE SUMMARY
      • * WELL-BEING
      • * DISRUPTIVE PROCESS
      • * AVAILABLE . ACCESSIBLE
      • * GLOBAL TASKS
      • * PARKINSON’S LAW
    • 4. GOALs
      • * supportive GOALs
      • * OPERATIONAL DESIGN
      • * Initiating GOVERNANCE
      • * Initial STRATEGIC  PLAN
    • 5. NATIONAL HEALTH Proposal
      • * ORGANIZE GOVERNANCE
      • * PURSUE ‘VISION’
      • * BUILD COMMUNITY
      • * MANAGE RESOURCES
      • * DEVELOP SKILLS
    • 6. Community HEALTH Forum
      • * Initial ADVOCATE Selection
      • * Initial ADVOCATE PANEL
      • * RESOURCE MONITORING
      • * RESOURCE AGREEMENT
    • 7. FOUR NATIONAL PROJECTS
      • * PHC BENEFITS PLAN
      • * PCP EDUCATION PLAN
      • * HEALTH SECURITY certif
      • * PHC EFFICACY PLAN
    • 8. APPENDIX
      • * BIBLIOGRAPHY
      • * GLOSSARY for Healthcare
    • 9. LAST WORD
      • * Author BIOGRAPHY
      • * Personal SURVIVAL Plan
      • * HAPPINESS
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