Fields of Black and White
Health and healthcare cannot be separated from legislation. The interdependent situation is not solely based in financial origins; integration gives assurances for areas such as public safety, anti-discrimination and decency of a modern republic. This interdependency is true within country borders, and the interdependency is increasingly true for a global population.
Limited pathways for private citizens may circumvent legislative bureaucracy from time to time. These limited pathways are not readily available to armed forces backgrounds. Both populations of the public are affected nonetheless.
People are not chess pieces, they are not grouped as eight players at a table, and they are not circus pawns. People drive, shape and constitute health. Establishing stronger expectations with health legislation removes inequalities and the risk of inequities. Establishing stronger expectations with health legislation ensures that no one is a pawn in another's hierarchical game of life.
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Shifting individuals away from the role of pawns in a game begins with removal of the board. A selective black and white board forces some to remain in confines; a selective grey is often the board of choice only when convenient for bureaucracy. And while some interpreters, such as Holmes, find that "the great ordinances of the Constitution do not establish and divide fields of black and white"(1), the black and white of healthcare is imposed on members of the public.
It is unacceptable for executive, legislative and judicial branches to get grey when the mood strikes, yet demand those dependent on health legislation remain in the confines of black and white delivery. We needn't have a board placed under our feet, colors dictated by others who are unwilling to wear the jerseys. Establishing appropriate expectations for black and white, and establishing appropriate expectations for grey, ensures that no one is a pawn in another's hierarchical nonsense.
Black and White
Helping legislators with a new black and white fit is a warm welcome to the equal team they are playing for. And who doesn't love to fashionably match their equals in all aspects of life?
- Quantity and quality of current and pending legislation should be clear.
- Measure the current legislation in healthcare. The sheer number of current, health-related federal and state laws, rules, resolutions and acts should be cataloged and easily accessible. The number of current legislative pieces should also be searchable by population base and/or affected health component. We should know how many rules, laws and resolutions are a part of the current healthcare delivery process for members of the military or veterans. We should be able to access how many rules, laws and resolutions are a part of the current mental health delivery process. And of the 931 bills and resolutions for this session in Congress, we should be clear about how many directly affect military populations (2). Totals by the numbers, cataloged, is a good start.
- Measure pending legislation in healthcare. The pending legislation of health-related federal and state laws, rules, resolutions and acts should tracked by length of time, population affected, similar legislation, affected and connected legislation.
- Track legislation. The tracking of legislation should opt for one database and system, as opposed to non-profit silo. For example, tracking legislation by pending deadlines (3), with an emphasis on pandemic emergency, could have already been resourced in a comprehensive tracker. Tracking should be legible for the average member of the public as opposed to the oft tangents, like the tangents of how a bill becomes a law.
- Initiate quality to reportable metrics. The quality of current and pending legislation should be initiated. Political, law and special interest have undoubtedly attempted to assign quality to legislation: by detailing pending legislation's risk to government overreach or risk to special populations, by detailing likelihood of approval, by detailing ongoing harm absent the approval, by detailing other considerations such as lobbyist influence. Of the 931 bills and resolutions (2) assigned in this Congressional session alone, which delays are unnecessary and which delays are causing harm? Major aspects of legislation should be considered for quality indicators.
- Qualify and quantify legislator plays. Legislative actions should be quantified and qualified based on motive. Healthcare legislation that does not pass and healthcare legislation contingent upon a politician's other legislation should be tracked. Healthcare that is negotiated at the individual Congressperson level, or as a political group, should be reviewed.
- Be transparent with lobbyist metrics. Lobbyist interest, involvement and shades of grey should measured, tracked and available to the public.
- Live in today's world. The current world has been affected by centuries of legislation, some of it enacting tremendous federal oversight. Origins of the Constitution may have required a slow legislative process for thoughtful uptake, yet a slow legislative process to redesign current government over- or under-reach may be causing ongoing harm to populations. Legislative involvement in executive branches, judicial branches or private interest have also evolved over time. The grey areas of federal crossover should be accountable to ongoing harm, too. Live in today's world, and set the expectation that the United States political realm do so as well.
- Prepare international collaborations for eventual performance assessments around policy creation, development, enforcement and quality with a matter-of-fact messaging strategy.
Grey
Assisting legislative bodies in navigation of a uniform grey relies more heavily on descriptors and qualifiers, because there are just so many shades of grey.
- Report on the administrative rules that affect the public's health as best possible. Give definition and clarity to how many administrative rules from government agencies have circumvented Congressional oversight, how many of them have accounted for public comment and how the public comments have affected the rules. Incorporate metrics on Congressional influence, including financial influence. This report should spotlight influence on rule decision-making by agency.
- Hold Congressional influence on rules accountable and include quality to reports on the Congressional Review Act (4).
- Report on administrative law judge actions and influence on the public's health. Measure branch influence.
- Detail legislation that affects private healthcare, how it affects private healthcare and the consequences for public healthcare delivery.
- Hold Committees accountable to the grey crossover that affects legislative inefficiency. In example, what conversations between VA leadership and Congressional authority have stalled, delayed or advanced legislation against advice (6)? And how is the public holding Congress accountable for their Committee work?
- Fund open access for legislative papers, including for those on lobbyist interest.
- Track advocacy openly and honestly. Online details on dates, actions, legislative conversations and advances should be clear. Be specific, regardless of cringe-worthy reporting. For instance, despite the absolute embarrassment surrounding federal legislative incompetence, detailing the amount of time and resource that groups like the VFW (7) and DAV (8) dedicate to advocating for what should be the expectation is helpful. Current legislation bureaucracy should also be detailed by prioritization of the advocacy groups, such as priorities to burn pit care from the American Legion and IAVA (9). While cringeworthy, detailing the ways in which the public is forced to scrounge for expected care also sharpens the accuracy of our representatives' collective character.
- Remove unequal healthcare privilege in Congress. Remove the ability for an equal member of the United States to receive lifelong, ultimate care without performance metrics that qualify their work in establishing similar healthcare for the public.
Links
1. https://tile.loc.gov/storage-services/service/ll/usrep/usrep277/usrep277189/usrep277189.pdf
2 https://www.congress.gov/browse/policyarea/117th-congress
3 https://www.crfb.org/blogs/upcoming-congressional-fiscal-policy-deadlines
4 https://sgp.fas.org/crs/misc/R43992.pdf
6 https://legiscan.com/US/pending/senate-veterans-affairs-committee/id/2333
8 https://www.dav.org/learn-more/legislation/
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