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i n i t i a l S T R A T E G I C P L A N
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A. ‘VISION ‘
STABLE HEALTH FOR EACH RESIDENT PERSON
B. MISSION
To stabilize the HEALTH of every resident person
with a continuously renewed understanding of our nation’s
Resources, Knowledge, and Human Dignity.
C. PRINCIPLES
1. Altruism
Our nation’s heritage began with traditions formed largely with our rural communities. These traditions reflected a reliance on individual responsibility, social cohesion, and their Family and extended Family for each resident person’s HEALTH. There was also a tradition of helping each others’ neighbors when life events have created special needs. These health benefits absent their associated community’s social capital, its social cohesion, are now provided by a very large, healthcare industry. For our modern-day healthcare industry, the challenge for NATIONAL HEALTH would be to sponsor the reform of our nation’s healthcare to achieve equitably available, ecologically accessible, justly efficient, and reliably effective health care for each resident person. Given the contemporary decline of each community’s social capital, NATIONAL HEALTH would promote each community’s collaboration with its adjacent communities for the benefit of each other’s Survival Commons (viz, augmented safety-net).
Success would be assured by each community’s level of commitment to their resident persons with special HEALTH needs. These needs would be defined as the developmental, social, or economic factors that adversely influence a resident person’s capability to achieve Stable HEALTH, especially during infancy, a continuing disability, homelessness, or a pregnancy. For each resident person encountering any of these HEALTH Conditions, continuously individualized Primary Healthcare offered responsively to each of these resident persons would represent the ultimate expression of Altruism by our nation’s healthcare industry.
2. Trust
No effort to promote change can succeed without a commitment to establish its trustworthiness as its agent of change. NATIONAL HEALTH must focus the execution of its own internal affairs to support this standard. The day-to-day character of NATIONAL HEALTH must achieve a widely acknowledged level of responsively-transparent leadership sustained over a long period of time. To the extent that each Community HEALTH Forum becomes trustworthy, the structural foundation for the MISSION of NATIONAL HEALTH will be firmly in place to rebuild our nation’s social cohesion for its population HEALTH.
David Mechanic offered a carefully considered analysis of our nation’s healthcare in his book published in 2008: THE TRUTH ABOUT HEALTHCARE. (24) Its Chapter 9 offers a view of the requirements for any strategy to improve trust in our nation’s healthcare. Also, Robert Hurley wrote his own analysis of the attributes for becoming trustworthy published in 2012: THE DECISION TO TRUST: How Leaders Create High Trust Organizations.
Finally, the level of trust within a community’s social interactions underlies its level of Social Capital for how each resident person resolves the social dilemmas they encounter daily within their Family, neighborhood, and community. Along with cooperation and reciprocity, the measurable attributes of social capital have been identified as a basis for improved, self-reported HEALTH. A multi-year study of the connection between longevity and poverty published in 2016 verified this relationship except for a few isolated communities. These isolated communities did not have the adverse effect of poverty on longevity. These communities exhibited an attribute that would represent a higher level of social capital such as the level of bonding, bridging, and linkage caring relationships within their community’s resident persons’ networks. 3.Cooperation To the extent that mutually-supportive relationships evolve through its PRINCIPLES, NATIONAL HEALTH would have the best opportunity to achieve improved efficiency and effectiveness by our nation’s healthcare. In the future, our nation’s healthcare industry will experience an increasingly more rapid redefinition of its MISSION at all levels of our legal, medical, social, economic, and innovation traditions. The renewal of these transitions will likely depend on how well the various competing vested interests are positively engaged in the underlying institutional reform process. Cooperation will be an essential attribute of the synergy necessary to successfully sponsor the immediate and continuing reform of our nation’s healthcare industry. The future challenges for our nation’s healthcare industry are profound. They include 1) our nation’s increasing Federal debt, 2) the number of citizens over the age of 64 years that will double between 2000 and 2030, 3) the currently unrecognized level of epigenetic and genetic diversity underlying each resident person’s HEALTH, 4) the adverse effects of climate change, and 5) the adverse effects of the world-wide internet on the social capital required for each community’s collective action projects intended to improve the Stable HEALTH of their resident persons.4. Reciprocity The political process ideally grows out of the reconciliation of alternate views of a problem or goal. This reconciliation is more likely to balance the legitimate vested interests associated with these alternate views when it reflects honest attempts at reciprocity. The ability to apply Trust, Cooperation, and Reciprocity to a social dilemma is commonly acknowledged as representing the social capital contribution for its resolution. For example, there were two somewhat distantly separated communities on the eastern coast of Japan that suffered extensive damage from the “worst ever” tsunami in 2004. Several studies evaluated the separate level of social capital for each community that accurately predicted each community’s resilience for their recovery. The community with a higher level of social capital recovered substantially more quickly. It is likely that the social determinants for each person’s HEALTH have historically evolved from substantially different processes, community by community. The nationally sanctioned strategies for healthcare reform occurring in 2018 show no signs of any progress for resolving the cost and quality problems associated with our nation’s healthcare. Most importantly, healthcare reform will need to resolve the character and distribution of Primary Healthcare that is offered within each resident person’s community. Secondly, there are no current means to locally individualize our nation’s disaster preparedness at the community level. For an influenza pandemic, it will preferentially affect young children and the elderly. In each community’s hospital Emergency Department, how will these Emergency Departments work together with reciprocity to allocate the scarce resources for artificial respirators within their community? And, third, what are the alternatives available within each community to invest in the social capital attributes necessary for each woman during a pregnancy? The ability to search for alternatives that are uniquely appropriate for each community should be directed locally based on an established community commitment, such as a Community HEALTH Forum.The need for pervasive Reciprocity among the legitimate vested-interests will be profound. For a national commitment, nearly 800 communities would be identified. The population for each would average @400,000 based on geographic area and population density. It may be viewed as a generational commitment with a 10-15 year startup phase. The focus on local Reciprocity will be vital as the effort to solve the cost and quality problems with our nation’s healthcare industry take on a new reform strategy. Reducing its health spending by 30% as its portion of the national economy and reducing our maternal mortality incidence by 70% will, at a minimum, require an invigorated expression of Reciprocity as well as Cooperation and Trust within the municipal life of each person’s community.
5. Excellence
* John W. Gardner said, “Excellence is doing ordinary things extraordinarily well.”
* Pat Riley said, “Excellence is the gradual result of always striving to do better.”
* Colin Powell said, “If you are going to achieve excellence in big things,
you develop the habit in little matters. Excellence is not an exception,
it is a prevailing attitude.” AND
* Thomas Peters and Robert Waterman, Jr. wrote a book published in 2006
with the title of “IN SEARCH OF EXCELLENCE:
Lessons learned From America’s Best-Run Companies.”
D. STRATEGIC PROJECTS
1. SHORT – TERM (one year)
a. Approve the Policy Operational Statement for the OPERATIONAL
PRINCIPLES of NATIONAL HEALTH and its basic implementing
Procedure Operational Statements;
b. Approve the Policy Operational Statement for the geographic boundaries
of the 9 Regional Councils, 81 District Coalitions, and <800 Community
HEALTH Forums including their initial metropolitan home-office locations;
c. Approve the Policy Operational Statements for the Member Selection Processes
of the Regional Councils, District Coalitions, and Advocates;
d. Approve a Policy Operational Statement as a template for each Regional Council
to establish a comprehensive strategy in collaboration with their District Coalitions
for initiating and sustaining their respective Community HEALTH Forums;
f. Identify regional and national leaders associated with the three National Projects
as Advisory Panels to collaborate with the Board of Trustees to establish
Policy Operational Statements within 6 months for
i. the PRIMARY HEALTHCARE BENEFITS PLAN,
ii. the PRIMARY PHYSICIAN EDUCATION PLAN, and
iii. the HEALTH SECURITY certification PLAN;
f. Initiate Regular Meetings of each Regional Council within 3 months
following the initial Meeting of the Board of Trustees;
g. Approve the Policy Operational Statement for the Employment Selection
of Associates for the Board of Trustees, Regional Councils, and
District Coalitions;
g. Select three Regional Councils for an initial trial of establishing
their 9 District Coalitions and at least 10 Community HEALTH Forums
among these initial District Coalitions within one year
following the initial Meeting of the Board of Trustees;
h. Initiate an annual Professional Achievement Plan for each Member, Associate,
and Advocate within 1 month of their initial appointment or employment
including an initial and continuing institutional supportive strategy;
i. Define a periodic process for validating the annual portion of the national
Gross National Product devoted to our nation’s health spending,
j. Prepare an initial concept for annual, all-payer reporting of nested,
justly efficient financial risk-management by community providers
and institutional payers at all levels of private and public payers, and
k. Assuming annual Federal support of $.150 per citizen per year, as cost of living
adjusted annually after 2020, allocate this revenue based on the
following distribution:
COMMENT Conceptually there are three Mega-Regions as defined by three regions of contiguous states with nearly equal populations within Northeast, Southeast, and Western portions of our Nation’s states and our protectorates, each with nearly 107 million citizens each in 2017.
i. 2% for three University-based Schools of Public Health, one per mega-region,
to maintain a continuous mapping strategy to assess the equitable availability
of Primary Healthcare to support the responsibilities of the mega-region’s
communityHEALTHforums,
ii. 2% for three other medical schools that periodically rotate, one per mega-region,
for demonstration projects intended to consider enhancements of their
medical school’s undergraduate and post-graduate learning strategies
sustaining equitably available Primary Healthcare,
iii. 2% for three other medical schools, one per mega-region, for establishing
a comprehensive continuing education curriculum in conjunction with
each other to fulfill their future mega-Region’s needs for equitably available,
ethnographically accessible, and reliably effective Primary Healthcare.
iv. 14% for the Board of Trustees and is Home Office affairs, Rany-day-fund, and
Management Information System,
v. 17% to special project grants as identified by the Board of Trustees, especially
training systems for Members, Associates, and Advocates including
Design Principles for Common-Pool-Resource management and
primary Social Determinants of HEALTH, AND
vi. 63% to the Regional Councils and their respective District Coalitions for their
participation in the decentralized governance of NATIONAL HEALTH;
2. LONG – TERM (4 years)
during the first four years with the preparation of a comprehensive strategy
for a NATIONAL HEALTH self-assessment of its ability to demonstrate
the new strategy based on its PRINCIPLES of Altruism, Collaboration,
Excellence, Transparency, and Trust;
ii. Finalize Three National Projects for the
PRIMARY HEALTHCARE BENEFITS PLAN,
PRIMARY PHYSICIAN EDUCATION PLAN, and
HEALTH SECURITY certification;
iii. Promote 81 functioning District Coalitions, each with a full complement
of Community HEALTH Forums within two years; and
iv. Reduce the proportion of the national economy devoted to healthcare spending
from X% (average of health spending as percent of GDP during 2 years
before the initial Meeting of the Board of Trustees) to X-2% of the GDP
during the 4th calendar year after the initial Meeting of the
Board of Trustees;
COMMENT In 2018, our nation’s healthcare spending represented 17.8% of the gross domestic product (GDP) or $3.73 Trillion. The GDP in 2018 was $20.94 Trillion. Assuming GDP growth at 3% annually for three years, the GDP in 2022 would be $23.57 trillion. A reduction from 17.8% to 16.8% would represent health spending of $3.96 Trillion for our nation’s healthcare during the fourth year, based on 2018 data: an increase of $23 Billion (instead of the anticipated increase of $47 Billion). The ultimate GOAL is a reduction by 5% (from 17.8% to 13.0%). The actual spending change may be less depending on overall economic growth, especially as it encounters a smaller allocation to healthcare spending. This would be a major stimulus since the reduction of health spending would lower the cost of Medicare/Medicaid to the Federal treasury, 45% of health spending in 2018.
v. Initiate a Plan for a 2-year evaluation beginning 5 years after the date
of the initial Meeting of the Board of Trustees to reassess
the Congressional Charter and its future options for promoting
the adaptability of our nation’s healthcare;
vi. Reduce the state by state variability as compared to the best 9 states average
of the Maternal Mortality Ratio by 50%;
vii. Promote the certification of as many HEALTH SECURITY clinics as necessary
to offer enhanced Primary Healthcare to 10 million citizens within each Region; and
COMMENT This would involve approximately 2,500 Primary Health Care clinics within each Region, about 30 per CommunityHEALTH Forum.
viii. Initiate Federal legislation as necessary to support the implementation of each
A) Community HEALTH Forum including
1) clarification of any potential restraint of trade issues and
2) arrangements for improving the financial support
of certified Primary Healthcare clinics
serving chronically under-served locations AND
B) the national reporting of financial efficiency for resource allocation
by each HEALTH SECURITY certified Primary Healthcare clinic.