NATIONAL HEALTH usa

Improving our nation's POPULATION HEALTH and >>>> <<<< its PRIMARY HEALTHCARE "…for everybody."

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a. SUPPORTIVE GOALs

h u m a n i t a r i a n     m a n d a t e

                               

 

                           

                                            

 

                                                                                                        

                                                                             

 

                                                 

                   

S u p p o r t i v e       G O A L s

             

 

                                       

 

                                         

                                         

                                  

                                      

                                            

                                                                                      

                                                                                         

 

11 pages                                                                                —   1   —

INTRODUCTION                                                          

 

                                                                                                                   

VOLUNTARISM

                         

“VOLUNTARISM is a theory of action according to which the ‘will’ takes precedence over the ‘intellect.’  The ‘will’ is traditionally understood as the faculty that forms intentions and then makes decisions and choices.  The ‘intellect’ is understood as a cognitive power, with both theoretical and practical components.  The theoretical ‘intellect’ is responsible for thinking and forming beliefs, whereas the practical ‘will’ is responsible for forming judgments regarding what is best to do.”      (Wikipedia)                                  

                                                                                                                       

 

EARLY NINETEENTH-CENTURY PHILOSOPHY 

The analysis of history could easily identify instances of social or political change based on the ‘will’ as well as instances of change fostered by the ‘intellect.’  Queen Elizabeth I was the reigning monarch of England from 1558 thru 1603.  To repair the financial status of her nation at the beginning of her reign, the ‘intellect’ of Queen Elizabeth I decided to avoid her involvement in foreign wars or marriage to build her nation’s internal welfare.

   This commitment led to worldwide English prosperity for 300 years following her reign.  The decision to use nuclear energy to end WWII may be another example of the ‘will.’  Somewhere between the ‘will’  and ‘intellect’ lies a dialectic underlying the evolution of ecological and cultural change over time.                                                                                                       

GOALs  

The  NATIONAL HEALTH Proposal  reflects a bias that resolving the paradigm paralysis afflicting our nation’s healthcare industry should initially follow the ‘intellect’ as represented by a strategy formulated from the confluence of uniquely connected ideas and concepts.  Ultimately, the ‘will’ of our nation’s humanity, community by community, will be necessary to sustain the initial release of the paradigm paralysis as the basis for a continuously self-reforming healthcare industry.           

   Beginning the first day after its initial MEETING, the Board of Trustees for NATIONAL HEALTH will depend on the ‘will’ of individual resident persons, community by community, who chose to mold their volunteerism through the ‘intellect’ of collective action. 

           

                             

                          

supportive  GOALs

This Sub-Page describes a limited number of underlying commitments that are likely to contribute significant guidance, among many alternatives, while NATIONAL HEALTH focuses on its initial GOALs.

These  supportive GOALs  are:    

 

I.  To initiate the  NATIONAL HEALTH Proposal 

            with humility and honor by fostering

            *  Polycentric governance that promotes the

                        widely acknowledged importance

                        of broadly-collaborative community support; 

            *  Career Formation Accords by all Primary Care Providers 

                        to enhance the availability of Primary Physicians 

                        for each resident person within every

                        community;   and 

            *  Renewed national traditions that demonstrate 

                        improving levels of prosociality for 

                        ^  Resolving the apparent as well as real

                                    conflicts of interest occurring within 

                                    Population Health, 

                        ^  Encouraging the participation of medical schools 

                                    in the uniform promotion 

                                    of equitably available 

                                    Primary Healthcare clinics within 

                                    every resident person’s community,  And 

                        ^   Promoting the development of financial support

                                    by the Federal government for each State’s 

                                    responsibility to offer their resident person’s 

                                    access to universal health insurance.   

                                                                                                                                                                                                   —   3   — 

                         AND 

 

 II.  To promote a community by community commitment to assure that 

            *  Caring relationships endure within and among the members 

                        of each resident person’s Family, Extended Family, and 

                        their Home’s Close neighborhood as the foundation 

                        for sustaining each resident person’s  Stable Health; 

            *  Each resident person’s Primary Healthcare Team is 

                        recognizable as a Therapeutic Community that 

                        ^  Offers responsive, caring relationships during

                                    any encounter for health care  and 

                        ^  Mindfully recognizes those persons afflicted by

                                    special ecological of cultural accessibility 

                                    needs such as infancy, disability, poverty, 

                                    homelessness, or each woman who is or 

                                    may be nurturing a pregnancy;   And 

            *  Each community’s  Survival Commons  flourishes

                        from the collaborative connections with its 

                        adjacent communities. 

 

                   

DISCUSSION  

          

NATIONAL HEALTH as proposed would be a monumental challenge for our nation.  On its own, NATIONAL HEALTH would not succeed solely as a result of its New Strategy or its meritorious ideals.  At all levels of the healthcare industry, a voluntary acknowledgment of our nation’s heritage will be required, particularly as it applies to the current character of our nation’s healthcare.  Rising up from the doldrums of our traditions will be required.  We should not abandon them but redirect them  1) especially for our Basic as well as for the Complex Healthcare Needs of each resident person and  2) for the autonomy of our nation within the worldwide community of nations. 

      

   As a democratic republic, we are a nation that is based on the most successful political and economic innovation among the world’s developed nations.  Our nation now needs to focus on its humanitarian mandate for the Basic Healthcare Needs of each resident person.  NATIONAL HEALTH  could become the catalyzing energy for refocusing our commitment to the heritage of our nation, especially a newly identifiable mandate to enhance the Survival Commons within each resident person’s community.   

   

GOVERNANCE

A special PERSPECTIVE written by John Iglehart appeared in the April 2, 2009 edition of the New England Journal of Medicine. (Inglehart 2009)  The author presents the results of an analysis that compares the level of health spending for our nation’s healthcare with the level of health spending by 14 nations and then another 42 developed nations of the world.  It demonstrates a general correlation between the wealth of a nation and the nation’s annual spending for their citizen’s healthcare, except for the “United States.”  Based on this analysis, our nation’s healthcare for each resident person may be spending 25-30% more of our national economy every year for healthcare than these other nations spend.  For 2019, this means that instead of spending 18.0% of our gross domestic product on national health care, it could have been 13% with no change in its quality.

      

   For our nation, this difference would have represented at least $1.05 trillion in 2018 alone.  In 2015, an improved level of efficiency would have been more than enough to pay the health spending required for the 16 million citizens without health insurance and improve the financial condition of our nation’s Federal government.  It is a very sobering analysis.  The financial implication is simple.  Inadequate efficiency is the principal problem of our nation’s healthcare industry. 

      

   Unseen and unrecognized, our nation’s level of healthcare inefficiency is the proverbial “elephant in the closet.”  Also unseen and unrecognized, the “elephant” is profoundly affecting our nation’s economic participation in the world’s marketplace for its Resources.  We are now a debtor nation rather than a creditor nation.  This state of economic dependency diminishes our nation’s autonomy within the worldwide community and the worldwide marketplace arenas for its  Knowledge and  Human Dignity.                                                                                —   5   —

      

   For improved efficiency, the  NATIONAL HEALTH Proposal  PAGE and its Sub-Pages describe a precisely focused, new institution for sponsoring the reform of our nation’s healthcare.  NATIONAL HEALTH would adapt the historic traditions of our nation’s healthcare as the basis for resolving the problems causing its inefficiency.  Since the uneven effectiveness of our healthcare also requires improvement, reforming the healthcare industry will not be easily achieved.  Ultimately, the reform process will require widely acknowledged, public support as the basis for promoting the necessary changes.  The governance for NATIONAL HEALTH is purposely structured to warrant the national support needed to reform our nation’s healthcare.  The “polycentric governance” concept of Elinor Ostrom for averting a “Tragedy of the Commons” is the guiding focus for the NATIONAL HEALTH Proposal.  

                        

CAREER  FORMATION  ACCORD   

The transformation fostered by  NATIONAL HEALTH  will need an extended period of time to achieve the full expression of its  VISION,  MISSION,  and  PRINCIPLES.  The eventual outcome following the implementation of the  Proposal  would be defined by its success in promoting enhanced Primary Healthcare, especially to the extent that it is equitably available to each resident person within their own community.  We anticipate that the essential contributors would be the nearly 810 Community HEALTH Forums involving local stakeholders including Primary Physicians, public health departments, and community hospital systems as they reduce the barriers to enhanced Primary Healthcare within their own community of @400,000 resident persons.  Beginning with a Regional Council baseline evaluation, a systematic plan for reducing these barriers would be adopted and the required resources identified within each community to establish their own Community HEALTH Plan, as formulated by its Community HEALTH Forum.

         

   The most important attribute of enhanced Primary Healthcare will be the responsibility within each clinic to foster a Career Formation Accord by each member of its staff, especially their Primary Care Providers.  Currently, the professional commitment necessary to manage the high level of uncertainty associated with Primary Healthcare creates a daily level of conflict resolution that is very difficult for any Primary Care Provider to endure.  Given the breadth and variable depth of unexpected uncertainty characterizing Primary Healthcare, each Primary Physician (or Nurse Practioner and Physician Assistant) works at a very different level of emotional, technical, and managerial complexity as compared to the other medical specialties.  A review of the HEALTH STORIES Sub-Page of the  HEALTH PROSPECTUS  PAGE offers a description of the residnet persons who need an intense level, often daily, of accountability by any physician, but especially their Primary Care Physician.  Having a self-renewing process to help each Primary Physician structure the priorities for their own professional career will be essential for responding to the evolving intensity required by any of their caring relationships, personal as well as professional.

        

   NATIONAL HEALTH  would foster a general commitment at all levels of the healthcare industry to support the professional career of the physicians who offer healthcare to our nation’s resident persons, especially by each Primary Physician.  In 1991, Peter Drucker described the importance of improving the business assets represented by the professional personnel within any information asset-based institution. (Drucker 1991)  A Career Formation Accord, annually mentored and revised, would be the most important strategy for sustaining the professional assets required for Primary Healthcare.

  

SUPPORTIVE  TRADITIONS

In addition to Primary Healthcare, there are many other institutions in our nation that will need to make a special commitment to actively collaborate with  NATIONAL HEALTH.  The Federal government will need to support the efforts within each state to help sponsor universal healthcare insurance for each of its resident persons.  Any new Federal requirements for each state to support nationally sponsored Universal Health Insurance must have a reasonable and guaranteed commitment from the Federal budget, especially for those resident persons who require an intense level of healthcare for their Complex Healthcare Needs.  Without this level of assistance, it would be difficult for any state to also support the involvement of its Department of Public Health in the affairs of  NATIONAL HEALTH.                                                          —   7   —

  

   The pharmaceutical industry will need a renewed commitment to excellence and altruism.  The essential attributes of product development, marketing, and manufacturing will need new prosociality priorities, viz., Trust, Cooperation, and Reciprocity.  To forestall price controls, the time-honored business model for pharmaceutical institutions will need revision, especially its unusual profit margin.

 

   Similarly, there are other conflicts of interest that exist at virtually every level of the healthcare industry.  In spite of the collaborative efforts of  NATIONAL HEALTH,  special Federal legislation may eventually be necessary to promote a comprehensive approach to resolving the persistence of pervasive conflicts of interest within the healthcare industry.  This applies especially to the co-dependent relationship between the payers of healthcare and the hospital systems devoted substantially to the healthcare of Complex Healthcare Needs.  Any pervasive conflict of interest that adversely affects the institutional  VISION,  MISSION,  and  PRINCIPLES  of  NATIONAL HEALTH  would require the most immediate identification and resolution.  

  

   The health insurance industry will need to sponsor innovative funding options for enhanced Primary Healthcare.  Certain clinics will likely demonstrate a unique ability to offer effective and efficient health care. It would be helpful to all levels of healthcare for the health insurance industry to identify these clinics as a means to form a less adversarial, suspicious operating character with physicians having the skills to offer and arrange efficient and effective healthcare.  The budgetary and actuarial challenges of health insurance require a unique institutional culture for its success.  Even if unintended, the industrial face of health insurance companies often implies an adversarial attitude regarding the personal priorities of their “members” and the health professions.  For the health insurance institutions, acquiring the skills necessary to express the norms underlying social capital for resolving the social dilemmas occurring for their members and each Primary Healthcare clinic should be an outgrowth of  NATIONAL HEALTH. 

 

Last but not least, medical schools have a unique role to assume for the success of the  NATIONAL HEALTH Proposal.  It is instructive to identify the unique institutional character of a medical school.  With one long-enduring exception, virtually every other scholarly endeavor within a university defines its institutional value to society by setting itself apart from the municipal life of society.  In fact, it is this separation that best defines those university efforts that are likely to be of most value for a future renewal of the  Knowledge  required for each resident person’s survival.  As compared to the remainder of any university’s activities except agriculture, each medical school is directly responsible for the healthcare of many resident persons with very Complex Healthcare Needs.  Importantly, it is the economic activity involved in the research and health care for these Complex Healthcare Needs that defines the identity as well as the financial stability of most, if not all, medical schools.  The dominating economic influence of healthcare and research for Complex Healthcare Needs has unintentionally diminished the importance of Primary Healthcare for each person’s HEALTH as a priority within the medical school academic environment.  The resultant impact on the priorities for preparing physicians to function as a Primary Physician is profoundly discounting and pervasive, even if unrecognized and unintended.

      

   NATIONAL HEALTH would offer a select group of medical schools the financial support needed to more fully immerse their connection with each clinic’s operational requirements for offering Primary Healthcare within a community of resident persons.  With its connection to 810 Community HEALTH Forums, NATIONAL HEALTH  would have a unique opportunity to sponsor a greater level of active immediacy within each medical school regarding the importance of enhanced Primary Healthcare for the Basic Healthcare Needs of each resident person, community by community.

                                            .                                        

   Each Forum, as proposed on the  Community HEALTH Forum  PAGE, would replicate for healthcare reform the provisions established for the Cooperative Extension Service within agriculture, established by Congress with the Smith-Lever Act of 1914.  In stark contrast to our nation’s healthcare industry, our nation’s agriculture industry is the most efficient and effective among the developed nations of the world.  Meanwhile, our healthcare industry represents the least efficient healthcare industry among the developed nations of the world with undeniable gaps of quality.  A New Strategy and Four National Projects for healthcare reform must progressively promote an engaged connection by our nation’s medical schools with the front line of Primary Healthcare, much as the Smith-Lever Act od 1914 has done for agriculture.

  

PERSONAL  HEALTH

Our national health priorities need a counterbalance to the exaggerated level of entitlement that characterizes the expectations of many persons who seek health care.  As a result of these expectations, our nation’s healthcare has become increasingly involved with offering health care for life-style related HEALTH Conditions.  For example, the increasing number of resident persons with obesity and its related health problems could be characterized as an epidemic.  Historically, there is no specific health insurance benefit for obesity-related health care except for bariatric surgery.  Truly, this represents the greatest anachronism for healthcare: risky healthcare to solve the adverse effects of a lifestyle problem.  Similarly, chemical dependency, profound mental health conditions, and homelessness are issues that are very complicated for a Primary Healthcare clinic and inappropriate for any hospital’s Emergency Department.  I am aware that an isolated metropolitan community has arranged a community-wide mental health hospital and “emergency” center just for these very complicated health conditions.           —   9   —

 

   To achieve appropriate expectations for our nation’s healthcare, many of our social institutions will need to foster new traditions that demonstrate a connection to the contemporary needs of each resident person’s HEALTH.  In the future, effective and efficient health care will require an improved level of self-discipline by each resident person regarding their own HEALTH.  In short, every person will need a renewed commitment to better living.  As a prerequisite for achieving Stable HEALTH, the basics are certainly well-known:  1) restful SLEEP, good FOOD, dedicated EXERCISE, and mentored COURAGE;  2) meaningful involvement in the needs of the community starting with each person’s own education and employment;  3) participation in a family-focused spiritual community as a basis for refining one’s personal values, and  4) a long-term commitment to actively support the caring relationships and Family traditions originating from within each person’s own Family.  To honor the evolving character of our multicultural society, the specific attributes of the basics will vary considerably from person to person.  Furthermore, the basics should represent an ecological and cultural inclusive reconciliation by each person as a basis for achieving their own level of  Stable HEALTH.

 

   The historic roles of certain institutions within our society are undergoing great change, especially churches, neighborhoods, schools, and the media.  Our nation’s healthcare industry should be included on this list.  NATIONAL HEALTH  could be viewed as an effort to refocus these changes as a means to improve each person’s priorities for healthy living.  Importantly, this should also achieve improved social cohesion at all levels of society.  Even with this national priority, “Stable HEALTH  For Each Resident Person” still begins with a need to recognize that restful SLEEP, good FOOD, dedicated EXERCISE, and mentored COURAGE are the essential basics for the  Stable HEALTH  of every person. 

   

SOCIOECONOMIC  ADVERSITY      

Importantly, the  NATIONAL HEALTH Proposal  begins with the proposition that our nation’s healthcare industry has the ability to achieve a very high level of uniform quality.  The central problems currently creating the uneven levels of quality are  1) the socioeconomic determinants for which Primary Healthcare is variably unable to offer equitably available as well as ecologically & culturally accessible health care to each resident person, especially for each resident person who is an infant, homeless or disabled, and every woman during a pregnancy and  2) the absence of any nationally sanctioned institution to uniformly promote enhanced Primary Healthcare for the Basic Healthcare Needs of each resident person, community by community.  The socioeconomic determinants range from the special HEALTH needs of almost any resident person to the group attributes of an entire community.  A single mother without a supportive Extended Family represents the individual extreme.  The children who have lived in a section of Omaha with yards and playgrounds heavily contaminated with lead represent a community extreme, largely resolved eventually by the Environmental Protection Agency.

 

   Since 1969, the technical advances in the character of our nation’s healthcare have evolved very rapidly.  The ability of our nation’s healthcare to implement these technical advances has not adapted as rapidly.  The outcomes produced by this disparity account for the steady worsening cost of our nation’s healthcare.  Among many other concerns about our nation’s healthcare, its most troublesome attribute is that it is terribly inefficient.  Even though there are other causes, the main cause for the inefficiency of our healthcare industry is its inability to responsively form caring relationships between each resident person and a Primary Healthcare Team as the basis for promoting their “Stable Health.”  This deficit disproportionately affects the resident persons who suddenly and unexpectedly require health care for very Complex Healthcare Needs.

                                                                                       

                                                                                       

 

                                                                                                  

VOLUNTARISM

NATIONAL HEALTH  will promote adequately funded Primary Healthcare through a nationally defined certification process to achieve a sustained improvement of its skill-set.  Each Primary Healthcare clinic maintaining a HEALTH SECURITY certified status would be eligible for a higher level of financial reimbursement.  Part of the certification process would emphasize the responsiveness of a clinic’s ability to foster the caring relationships required for any resident person to obtain equitably available health care that is ecologically & culturally accessible.  A renewed focus on our nation’s healthcare obligation to each resident person who is an infant, disabled or homeless as well as any woman during a pregnancy would be a very important attribute of success by  NATIONAL HEALTH.     

   

   As an institution, the success of  NATIONAL HEALTH  would be a reflection of its collective intellect as it fosters enhanced Primary Healthcare.  But for each individual person, the success of  NATIONAL HEALTH  would be the result of the collective ‘will’ as identified by the caring relationships offered by a Primary Healthcare Team to each resident person.  The Design Principles for managing a common-pool resource, as in the portion of our economy that is available for health spending, must be applied to all levels of our nation’s healthcare industry as a strategy for harvesting the intellect of our nation and offer its application for enhancing the ‘will’ of each resident person to achieve Stable  HEALTH  through the Survival Commons of their own community.                                                                           —   11   —

                         

                     

                              

  • Pages

    • 1. HEALTH PROSPECTUS
      • a. PREFACE & CONTENTS
      • b. DESIGN EPISTEMOLOGY
      • c. FIVE HEALTH STORIES
      • d. MINDLESS MENACE
    • 2. VINTAGE TRADITIONS
      • a. PROLOGUE
      • b. LEGAL
      • c. MEDICAL
      • d. SOCIAL
      • e. ECONOMIC
      • f. INNOVATION
    • 3. RECONFIGURED PARADIGM
      • a. WELL-BEING
      • b. PERSONAL SURVIVAL PlAN
      • c. DISRUPTIVE PROCESS
      • ** AVAILABLE & ACCESSIBLE HEALTHCARE
      • f. GLOBAL TASKS
      • g. PARKINSON’S LAW
    • 4. GOALs
      • a. SUPPORTIVE GOALs
      • b. OPERATIONAL DESIGN
      • c. INITIATING GOVERNANCE
      • ** INITIAL STRATEGIC  PLAN
    • 5. NATIONAL HEALTH Proposal
      • a. ORGANIZE GOVERNANCE
      • ** PURSUE ‘VISION’
      • ** BUILD COMMUNITY
      • ** MANAGE RESOURCES
      • ** DEVELOP SKILLS
    • 6. COMMUNITY HEALTH FORUM
      • a. INITIAL ADVOCATE SELECTION
      • b. INITIAL ADVOCATE PANEL
      • c. RESOURCE MONITORING
      • d. RESOURCE AGREEMENT
    • 7. FOUR NATIONAL PROJECTS
      • ** PHC BENEFITS PLAN
      • ** PCP EDUCATION PLAN
      • c. HEALTH SECURITY CERTIFICATION
      • d. PHC EFFICACY PLAN
    • 8. APPENDIX
      • ** REFERENCES
      • ** GLOSSARY FOR HEALTHCARE
    • 9. LAST WORD
      • a. AUTHOR BIOGRAPHY
      • b. HAPPINESS
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    • 1. HEALTH PROSPECTUS
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