• Ruth Lininger, MD MPH

Radically Redesigning Health Care; A Marshall Plan for Restoring Health for Our Communities

Foundational Principles

1. The goal of health care redesign must be to create the most effective, sustainable, affordable, health care model that both treats disease, prevents disease by addressing the root cause, and promotes health while at the same time providing a satisfying experience for both consumers and health care providers. Further, health access, health freedom, and health justice must be ensured while promoting and reinvesting in community, national health, and planetary health to further the virtuous cycle of building health, one person, one family, one employer, and one community at a time. Given the global pandemic superimposed on the epidemic of chronic disease, the unsustainable rise in health care spending, the threat of global warming, and the economic crisis, the matter is no longer if but how we will radically redesign health care. The health of our nation is a matter of national security and we must lead to a higher standard.

A Whole Health Solution

2. Because health is impacted by a myriad of determinants, a true solution for health reform must be a holistic solution.

a. Health involves a person in relation to their family, community, society, and environment, and a myriad of other determinants, including cultural, racial, ethnic, and gender determinants together with genetics, life experience, and lifestyle. Any one factor out of balance can negatively impact health. The solution must address the whole.

Health Governance and Policy Reform

3. National Health Branch

a. In order to ensure that effective health policy is created and implemented to promote public health and prevent and control disease, there must be a branch of government, a national health branch governing body, overseeing the health of the nation’s citizens, which can provide education, guidance, create health legislation, and advise on legislation and executive orders pertaining to health. This branch must have veto authority over any governmental decision deemed to violate the core principles of health promotion, disease prevention, and/ or disease control during a public health crisis. Senior members of the CDC, EPA, a reestablished and refunded Armed Forces Institute of Pathology (AFIP), NIH, and a supreme health court could compose a fourth health branch governing body. The CMS and VA Health systems and any other federal health system such as American Indian health system must also be represented in this branch. Leadership entities concerning marine, aquatic, and terrestrial wildlife and national parks and green spaces must also be represented, as well a commissions on global warming, air quality, and social and environmental justice.

4. Supreme Health Court

a. Members of a supreme health court must include interdisciplinary and preferably dually boarded clinicians, scientists and health attorneys and will be appointees that will serve a 10 year term. They should weigh in on issues arising in the supreme court concerning health law, health, and health rights.

5. Armed Forces Institute of Pathology (AFIP)

a. The AFIP must be reestablished and refunded and consist of a national organization of experts in pathology and laboratory medicine to inform, guide, and advise on matters of public health and national biosecurity, including expertise in the diagnosis of disease, providing oversight as a matter of national biosecurity for establishing and distributing and evaluating laboratory testing to ensure the failure in laboratory testing preparedness for the current pandemic never happens again.

6. Independent and Governing Authority of the CDC

a. The Center for Disease Control and Prevention must have independent authority to inform the general public, states, and the government on matters of health and disease, at will do so, without politicization, threats, or recrimination. Violation must be a codifiable offense. Members of the CDC may not be removed from office by actions of the executive or legislative branch against the advice of the health branch.

b. Consideration should be given for the CDC and EPA to be privatized, funded in part by governmental subsidies, state subsidies, and possibly also nonprofit donations from other health organizations whose aim is to protect and preserve our nations health and the health of the environment. Means to avoid politicization of our public health infrastructure, in order to restore to do what it is meant to do, to protect the environment must be assured. The organizations must be bipartisan and apolitical and science driven.

7. National Institute of Health (NIH) Merit-Based, Double Blinded Grant Review

a. NIH research grant review and funds allocation should be reformed to create a policy for double blinded grant review to permit the best ideas to be funded based on scientific merit and not cronyism

8. Integrative/ holistic health attorneys training and leadership

a. Integrative/ holistic health attorneys and leaders are needed to create and implement new laws and policy to implement these changes. Specialized training should be provided at leading law schools to meet this need and demand.

Health Economics

9. True economic cost must be factored into health policy and payor solutions.

10. Preserving the free market in this new paradigm is foundational, to preserve the ability to innovate, and continuously and rapidly improve the quality and affordability and distribution of health care technology, products, and services

11. Preventing medical and healthcare monopolies. All systems of medicine that consumers demand access to which demonstrate value including traditions based medicine must be recognized as medical care, including health care under alternative payor arrangements (eg. direct primary care, functional medicine, integrative medicine, etc…), as recommended by the leadership by each respective medical organizations governing body. No one medical governing body will be permitted to interfere with a competing organizations rights to practice, classification as “medical care”, or ability to seek permission to issue continuing medical education (CME) credits for programs provided to qualifying applicants

12. Creating economic value from health transformation and reinvesting to create a virtuous cycle of health

a. The health transformation of populations has the potential to create economic value through health “savings”. A proportion of this health savings if applied to drive the virtuous cycle of health within communities could affordably help to repair our local communities and environment and further promote future health gains to continue to drive down health care costs. Incorporating this as a sustainable health practice must be encouraged by businesses and would be a desired feature of innovative health plans.

Health Care Cost Transparency

13. Health care cost and any and all rules or contracts pertaining to determining health care cost must be transparent, to permit consumers the right to make informed choices about their health care.

Health Care Quality

14. Health care quality metrics must be available to consumers and they must be transparent, to permit consumers to make informed choices about their health care. Health care quality metrics must no longer be reported as ratings but as rankings, and measures of quality must be adjusted by lifespan according to geographic region and other variables such as zip codes and other social determinants of health of the populations being served, in order to provide accurate quality measures that can be standardized nationally. The means of assessment for ratings must be transparent. Health care quality and measurement leadership from each regions of the United States must come together to reevaluate, create, and refine a new standard for national use to permit meaningful evaluation of clinical and community health programs, in light of social determinants, and population health within different catchment areas. Only with accurate measures of consumer health and population health can meaningful evaluations of consumer, community, and population health interventions, outcomes, quality, cost, and value be assessed.

Health Rights and Health Law Reforms

Health Access

15. Universal Access to Health Care

a. All residents of the United States deserve access to health care regardless of the ability to pay for it.

b. There must be a safety net to provide essential and health care and preventive health services to individuals residing in America who cannot afford to pay for this care themselves

c. No person should have to lose their home or have to cash out their retirement savings in order to pay for medical bills.

Health Freedom

17. Health freedom must be a codified right for consumers of health care

a. Health freedom is the freedom for a consumer to chose a health care practitioner from a recognized health discipline of their choice, must be restored

18. State and federal rules that limit consumers access to the health care practitioners of their choice Health freedom must be revised

19. Individual health and medical associations will have authority to chose whether to be licensed or remain as unlicensed health care practitioners, as best benefits their organizations and members and the health of their clients

20. Medical and health practitioners of other healing disciplines, eg. naturopaths, Chinese medicine practitioners, and Ayurvedic practitioners, should be recognized as medical practitioners as they are in other countries, and clients who chose this care should be permitted to incorporate or substitute this care for allopathic medicine

Telemedicine/ Telehealth Parity

21. Medical care must be accessible to consumers across state lines, to be facilitated by a universal medical license application for those practitioners who chose to make their services available more broadly, for example for highly specialized providers to patients with chronic disease

22. Telehealth parity laws will need to be approved nationally to permit reimbursement for services performed, during and post COVID

Health Information Portability and Privacy

23. Consumers must continue to have the right to access their health data, in all its forms, and to make decisions about where and how it is used. This right must be expanded to the capture of data from wearables and remote monitoring devices.

Sustainable Health Care

24. A radical redesign for health care must be created to be implemented sustainably, to permit continuous and ongoing improvement to meet long term national and global health goals.

Scalable Health Care

25. A radical redesign for health care must be scalable, and permit implementation across geographic locations, age, race, language, education, and economic barriers.

Physician – Patient Relationship

26. Physician autonomy and the physician- patient relationship must be restored.

a. The autonomy of physicians to make the best decisions for patients and the primacy of the healing physician patient relationship must be restored.

Community Health

27. Creating sustainable local community health plan, resources, programs, and systems will be necessary to enabling sustained local implementation of community health goals and community health transformation.

Environmental Health

28. We must change the laws governing the assessment and determination of safety of environmental chemicals and exposures to human health, property, and environment in the United States. We must adopt and adhere to language stating that all new synthetic chemical compounds will be assumed to be unsafe unless and until exposure is deemed safe. Regarding classification of existing synthetic chemicals, they must be adhere to this same standard, and industry must replace unsafe chemicals and methodologies with those that are safer and more environmentally friendly over a reasonable period of time, or be fined and liable for all subsequent or prior findings of damage.

Health Care Intelligence and Reform

29. Health care intelligence and education incorporating artificial intelligence and machine learning will be critical to the new paradigm for systems based sustainable health design. But we must adopt this intelligence thoughtfully and ensure unnecessary bias is removed or adjusted for in order to avoid creating health disparities and inequities.

Pharmacy Intelligence and Reform

30. Pharmacists need to be trained in pharmaceutical sciences as well as nutraceuticals, including dietary supplements and botanical medicines, and to be trained in and to recognize drug-nutrient-herb interactions, for the best outcomes of their patients. Integrative or holistic pharmacy must be part of pharmacy education.

Laboratory Medicine Intelligence and Reform

31. Laboratory testing standards must be based not on statistical ranges of normal for our abnormally sick population, but standards of health as defined by our species

Global Health

32. A scalable solution that can be applicable globally and to underserved regions must built. Promoting global health must be a goal, even if long term, of any initial redesign, since our individual health is a global concern in this global economy.

Planetary Health

33. Restoring environmental and planetary health must be an integral part of the solution.

a. If the human race as a breakout species is unable to assure that we survive sustainably on this planet, we will be doomed to succumb to the fate of every other breakout species that has ever existed, namely overutilization of resources leading to species demise

b. We must focus our resources to saving this planet, in what is separately proposed as a Global Health Moonshot Program

Medical Education

34. Medical education in aspects of whole health care, including systems biology medicine, traditions based medicine, genomics, nutrition, diet, lifestyle, botanical medicine, and dietary supplements must be provided for medical students, residents, and fellows, and made available and encouraged for supervising and private practice physicians and medical staff to assist in the national transformation of health care and effort to reduce chronic disease via cost effective means incorporating these and other integrative strategies.

Health Communication

36. Communication and community are central to health and to an innovative solution. All citizens must have access to a means to communicate their health needs.

Health Data and Analytics

37. Health Care Data

a. Interoperability of health care technology and health care data collected should be a goal to be achieved within the coming decade, which will permit new insights and the ability to optimize care and identify new threats and respond more quickly.

Health Security

38. Patients health records should be private and secure and patients should control their health records and who they share their information with. Open medical records are also encouraged to drive patient engagement.

Health Technology

39. Health technologies that is open source will help to foster innovation, integration, and interoperability

a. Technology can facilitate these stated goals but ideally it should be open source to permit innovation by individuals and communities to create specifically tailored solutions

40. Universal access to internet and Wi-Fi connectivity

a. Everyone must have access to internet and wife connectivity (unless they chose to opt out), to enable consumer access to secure and meaningful health information in the home and on portable personal communication devices. Access to this technology will be treated as a basic human need, like power, electricity, heat, water, and sewer services.

Health Care Service Corp

41. A Health Care Service Corp must be created to advance health at the microeconomic level and to re-employ Americans, especially those who care about health

a. During the COVID pandemic and in response to the rising unemployed, the federal and state governments should fund a health care service corp consisting of peer to peer support for individuals and their health concerns. This corp will be screened for interest, skills, and education, and trained as health care service corp to implement public health education, laboratory testing, screening, contact tracing, and to work with clients to onboard individuals to health care system, resources, and to develop a personal health goals and a health plan. There will need to be a national and state peer support training programs, integrated into the above system of care.

The Health Reform Transition

42. There must be accommodations for the losers in the new paradigm

a. Like the Marshall Plan did for World War 2, there must be a plan for concessions to the major players that are losers under the new paradigm if they are not able to adapt. For those profiting under the existing model, and threatened by its obsolescence, it is imperative to provides avenues for opportunity and profitability for all existing major players under the new paradigm, to preserve the economy, the stability of the stock market, and investor and consumer confidence. This will be necessary for the stability of the economy and for the good of humanity.

You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.

Richard Buckminster Fuller

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Tel: 984-364-8441        rlininger@duchesshealth.com

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