103. The United States Health Care System Pyramid ꟷ A View From Space

Fixing United States Health Care - Letters to the File

Part I. The Hot Mess

Part II. The Solution

by

T Michael White MD FACP

www.fixingushealthcare.com

The Realization of Universal Access to ABC-STEEEP

(Affordable, Basic, Compassionate - Safe, Timely, Efficient, Effective, Equitable/Just, Patient-Centered Care)

******

103. The United States Health Care System Pyramid ꟷ A View From Space

“Vision is the art of seeing what is invisible to others.”

Jonathan Swift

“Vision without action is merely a dream.

Action without vision just passes the time.

Vision with action can change the world.”

Joel A. Barker

The WhiteHouse on the Belleair Bluff

Wednesday, November 5, 2025

Dr. Mike,

A letter to the file…

So, it has come to this. You have championed universal access to ABC-STEEEP (affordable, basic, compassionate, safe, timely, efficient, effective, equitable/just, patient-centered care) and now 1) The United States Health Care System (USHCS) has been legislatively established; and 2) you, quite logically, are in charge. To what do you owe your appointment? With all humility, it just makes sense. Clearly, your administrative, clinical, communication, ethical, fiscal, leadership, political and scientific expertise (not to mention your charm and good looks) has finally been recognized.

Where to start? As always, your vision comes into focus while playing two-club golf

alone in the afternoon. A links respite provides you with requisite breathing room to see the big picture ꟷ your view from space. Your above-the-atmosphere takeaways:

1. Appreciate and celebrate the current United States Health Care (non) System.

   Recognize its unparalleled expertise, innovation and potential and then explain that,

   because of inefficiency, inequity, non-performance and unaffordability, it must be

   dismantled and replaced.

2. Create The United States Health Care System inverted pyramid:

   (Pyramid Foundation)

   I. Robust (politician free) Evidence-based Public Health Infrastructure

   
   

   • Vaccinations

   • Cancer Prevention

   • Screenings (lipids, blood pressure, diabetes)

   • Covered Services (Requirements and Approvals)

   ******

   II. Personal Health Care Literacy

   • Education

   • Mobile phone

   • Personal computer

   ******

   III. Personal Health Care Responsibility (and Consequences)

   ******

   IV. USHCS Public Health Artificial Intelligence Center

   • 24/7/365 (compassionate, polite) Chat Availability

   • Vital signs

   • Creation and Maintenance of Personal Medical Record

   • Articulation of Advanced Directives

   • Identification of Health Care Surrogates

   • Assignment of age/chronic condition primary care team

   • Longitudinal (age/health specific) Education

   • Basic listening skills and Basic advice

   • Referrals: Relevant information (Cleveland Clinic/Mayo Clinic Library); Self-care;

   Pharmacist care; virtual care; Primary Care Team; urgent care; emergency

   medicine/hospital; and/or EMS.

   (note: referrals to specialists are done by primary care team)

   ******

   V. USHCS Pharmacy Prescription Plan

   ******

   VI. USHCS (modest) Supplements for Dental, Hearing and Vision Care

   ******

   VII. Personal Care

   • Virtual Care

   • Primary Care

   • Urgent Care

   • Emergency Medicine

   • Specialist Care

   • Hospice Care

   

   (Pyramid Apex)

3. Necessary disruption:

   • Create a personal and corporate income tax system that makes the USHCS

   • revenue neutral

   • Disband Medicare

   • Disband Medicaid

   • Disband the Veterans Administration Health Care System

   • Create an active-duty medical care system

   • Create a national system to identify, address, adjudicate and compensate harms

   • Divorce long-term domiciliary housing expense from USHCS

   • Permit parallel fee-for-service health care and insurance systems (neither

     subsidized by the USHCS) for individuals desirous of private health insurance,

     boutique care; catastrophic coverage; uncovered services; domiciliary services;

     etc.

4. Identify regional Medicare Advantage Plan 5-Star centers of excellence and appoint

   them as administrators of the program in their region. Such centers of excellence will

   demonstrate:

   • Commitment to ABC-STEEEP;

   • Ascendant quality and safety statistics (A-rated Leapfrog Hospital Safety Grade);

   • Superb customers satisfaction statistics;

   • Fiscal efficiency;

   • Commitment to the elimination of duplication of services;

   • Commitment to the elimination of fraud and abuse;

   • Comprehensive (information technology; public health medicine; primary care

   • team; urgent care; emergency medicine; in-patient, pharmacy; tertiary care; and

   • hospice services).

5. Ensure these foundational goals are realized:

   • ABC-STEEEP coverage extends from cradle to grave;

   • Basic coverage is defined (note: basic care cannot/will not be all things to all

   • people);

   • Modest co-pays (skin in the game). Refunded for compliance.

   • Co-insurance and deductibles are eliminated;

   • Coverage is portable throughout the United States;

   • A USHCS supplement is available to purchase to cover emergency services

   • abroad;

   • Each individual has personal responsibility for maintaining her/his health to the

   • best of her/his ability. Decent, kind, compassionate consequences will accrue to

   • those who habitually abuse their USHCS privilege;

   • Individuals who are not eligible for USHCS coverage are charged and billed the

   • same as USHCS patients when using USHCS facilities and services.

   • Fair and just compensation for our administrative and clinical ‘Better Angels’

   • who serve us so well will be ensured.

   • The USHCS will be revenue neutral (for emphasis, will never run at a deficit).

Dr. Mike, while walking off the course (having set the course record for a geriatric two-club golfer with a poor memory and an eraser), your vision has come into focus. It is now time for you (yes, it is always about you) to kick a few tires and take several age/gender test drives to explore 1) how the USHCS impacts your care; and 2) to begin to identify and address (dreaded) unintended consequences.

Respectfully submitted with fondest personal regards,

Dr. Mike

www.fixingushealthcare.com

You may leave an anonymous comment without username and email ꟷ please do. Please share your wisdom, insights and perceptions (your reality) about what I have right, wrong and/or omitted. I will be delighted to hear from you as this draft and subsequent chapters will be significantly enhanced.

Dr. Mike

Letters to the File ꟷ Part II

101. Introduction to Part II ꟷ The Solution

102. The Creation of the United States Health Care System ꟷ Enabling Legislation

103. The United States Health Care System Pyramid ꟷ A View From Space

(more to follow)

www.fixingushealthcare.com