NATIONAL HEALTH

It would be unfortunate if the ability of medical schools to attract the best students was impaired by their applicants’ perception of the current turmoil existing within our nation’s healthcare.  One view of this turmoil might point to the following.

       1) the locally unique adversities affecting the equitable availability of Primary Healthcare that is offered to each citizen,  

       2) the financial instability of the reimbursement systems that prominently impair the ecologic accessibility to the health care for Basic Healthcare Needs,  

      3) the unpredictable stability of physician work environments, 

      4) the level of indebtedness for medical school post-graduates and its effect on their family and career choices, and

      5) the absence of sufficient training to confidently manage their Career Achievement Planning responsibilities.

Attracting a skilled and dedicated “front-line” for healthcare requires a professional work environment that is stable, innovative and supportive of Career Achievement Planning for each Primary Physician and their associated Healthcare Team.  One possible view of this scenario is for  NATIONAL  HEALTH  to consider an indirect responsibility to facilitate professional renewal strategies from within each medical school, educational community.  Specifically, the future functions of a Primary Physician will require an enhanced knowledge base and skill set related to the depth and breadth of uncertainty characterizing the human dignity underlying a person’s Basic Healthcare Needs.  This will require a substantial shift in the ability of medical schools to model these functions from within their own institutional traditions.

In effect, a Primary Physician in 2019 represents a substantially different set of accountabilities as compared to the entrepreneurial physician of 1969.  Even so, there is still an unchanged need to preserve and “nurture” the essential attributes of the truly caring physician.  I thank Hasan Bazari, M.D. for his  “Becoming a Physician” essay  Gratitude, Memories, and Meaning in Medicine. (34)   I reproduced a single paragraph from his essay to open this Global Task for  NATIONAL  HEALTH. 

IMMIGRATION   

Currently, the total number of practicing physicians is substantially dependent on immigration.  There are many instances of especially talented physicians who have come to the United States and contributed greatly to the quality of our research and healthcare.  However, to what level should our nation encourage the immigration of these professional assets from other countries as a means to support our own needs to offer health care?  Is it possible that neither our nation’s healthcare nor our nation’s foreign policy benefits fully from the uncontrolled international immigration of physicians to our nation’s healthcare industry?  To the extent that the healthcare industry itself manages the availability of vital physician skills including the level of physician immigration from other countries, our nation’s healthcare will avoid the risks of inefficiency related to critical shortages of vital physician services, especially for Primary Healthcare.

PROFESSIONAL  RESOURCES

There is no current effort to achieve a national consensus regarding the education and work-environment requirements for our nation’s most important, healthcare asset: its physicians.  A slowly evolving, national plan for ensuring the comprehensive education of and the institutional adaptation for our nation’s Primary Physician resources would contribute to the equitable availability of physician services necessary for its  PRIMARY HEALTHCARE  BENEFITS  PLAN.   A   PRIMARY PHYSICIAN  EDUCATION  PLAN   could be a unique opportunity for assuring that our nation’s healthcare is able to attract and train the physicians who will eventually  1) have a high commitment to altruism and excellence and  2) as a group, represent a comprehensive capability to offer enhanced health care for Basic Healthcare Needs as well as the coordination of these Needs with any Complex Healthcare Needs that may be required.  An Editorial written by David Goodman, M.D. has described these issues succinctly.  The Editorial appeared in the September 10, 2008 issue of JAMA (6).

REGULATORY   ENHANCEMENT

The  Initiative  has one prominent downside in that it represents yet another isolated regulatory process.  It is a characteristic of any nation that the private sector may not uniformly provide for the  Survival Commons  of its citizens, especially for their  HEALTH.   In highly closed societies, the private sector functions largely “underground.”  For our open society, the primary role for government and non-profit institutions is to perform those functions for our nation that the private sector is unable or unwilling to accomplish.  One of these functions is regulatory control.  Typically, regulatory control usually means setting standards or governmental use of financial resources as incentives, such as grants or loan guarantees.   

The additional regulatory control by  NATIONAL HEALTH  could be justified by its national perspective.  This perspective is particularly important for medical schools, physician specialty board certification, hospital “Joint Commission” certification and their financial priorities.  Specifically, a priority is necessary at each of these levels to assure that enhanced Primary Healthcare is  equitably available  to and  ecologically accessible  by each citizen, community by community, as well as  justly efficient  and  reliably effective.  As introduced by Elinor Ostrom, the concepts associated with the Design Principles For Managing a Commons should apply.

As an extra role, the  new strategy  of  NATIONAL HEALTH  would add to its  new strategy  an obligation to replenish our Nation’s expression of  Social Cohesion.  Mobilizing collaborative processes at the community level has much to add for improving each citizen’s  HEALTH.   Originating in 1914, the model of the Cooperative Extension Service stands firm for the Agriculture Industry.  A similar model for our nation’s healthcare industry is long overdue. 

ELINOR  OSTROM

Within the  TRADITIONS  Page (see Tab above), the  INNOVATION  Sub-Page  presents a variety of concepts.  These concepts have not found a prominent place within the world-wide arena of Knowledge  for healthcare.  Among these ideas, the conceptual basis for  “Governing a Commons” is particularly absent.  Elinor Ostrom formulated a general theory for understanding how a connected group of people, a community, can move beyond property rights to initiate the collective action necessary to preserve a commons (common-pool resource).  The portion of our national economy represented by health spending is now exhausting our nation’s financial resources.  In 2009, Professor Ostrom received a Nobel Prize for her research.  Other than the isolated reference to an evolving “Tragedy of the Commons,” any connection to the nine books written or co-authored by Professor Ostrom beginning in 1990 does not currently appear within the knowledge arena of our nation’s healthcare reform. 

See the  MANAGING THE COMMONS   Sub-Page  for a broader discussion of the  new strategy  for healthcare reform based on Professor Ostrom’s  Design Principles for Managing a Commons.

GATEKEEPER  FOR  NEW  IDEAS 

The essential focus for pursuing a  new strategy  for healthcare reform is its  unjust efficiency  and  inequitable availability,  especially for the health care of Basic Healthcare Needs.  Beyond the immediacy of this crisis, the long-term stability of our nation’s healthcare will also be progressively assured by having a socially acknowledged and widely respected plan for the implementation of  a  new strategy  for healthcare reform.  The Paradigm for our nation’s healthcare must never be paralyzed again.  Preserving this long-term goal could be the most important safeguard, an institutional immunization, to be achieved by NATIONAL HEALTH.   As noted on the  RATIONALE  Sub-Page,  a national commitment reminiscent of a  “mission to the moon”  will be necessary.

CONGRESSIONAL  CHARTER  PROVISIONS  FOR  THIS  GLOBAL  TASK 

A.  NATIONAL  HEALTH  will authorize an   OPERATIONAL STATEMENT  for preparing, announcing and distributing an  Annual Report  regarding its progress for achieving its   GOALs  and the affairs of it’s  Board of Trustees,  Regional Councils,  District Coalitions  and  Community HEALTH Forums.  This report will coincide with any Report to Congress required by its  Congressional Charter.

[  COMMENT:   The  Annual Report  could be a vehicle to initiate a pre-planned staged process for a broader national awareness regarding the importance of contributing issues, such as the character of each person’s  Family  or the importance of each  Family’s  Micro Social Networks. ]      

B.  The Board of Trustees in conjunction with the Regional Councils and their District Coalitions will establish a national dialogue for assuring the availability of Primary Physicians, community by community, along with the related resources necessary for the  Basic Healthcare Needs  of each citizen within their own community.

[  COMMENT:  This commitment may be associated with the development and training of a  CRISIS INTERVENTION  Team  ( CIT ) for each of the Tripartite Mega-Regions located in the Northeast, Southeast and Western collections of states.  Each Mega-Region  accounts for  1/3  of our nation’s citizens.  The commitment of  NATIONAL HEALTH  to form its own  CIT  could initiate these  Mega-Region efforts.  Think Influenza Pandemic!  ]