104. My (Unique and Very Personal) United States Health Care ꟷGetting Started
- Nov 17, 2025
- 4 min read
Fixing United States Health Care - Letters to the File
Part I. The Hot Mess
Part II. The Solution
by
T Michael White MD FACP
The Realization of Universal Access to ABC-STEEEP
(Affordable, Basic, Compassionate - Safe, Timely, Efficient, Effective, Equitable/Just, Patient-Centered Care)
******
104. My (Unique and Very Personal) United States Health Care ꟷGetting Started
“Disciplining yourself to do what you know is right and important, although difficult,
is the highroad to pride, self-esteem, and personal satisfaction.”
Margaret Thatcher
The WhiteHouse on the Belleair Bluff
Friday, November 14, 2025
Dr. Mike,
A letter to the file…
The United States Health Care System (USHCS) is a fact. And, appropriately, you ꟷ the USHCS Czar ꟷ are the first citizen/client/patient to interface with the system. Here are your observations:
Telling yourself the truth, you recognize the former (non) system was clinically and
financially unsustainable and had put individual career, food, education, finances,
health, home, and transportation securities and community and national security at risk.
Therefore, you are most willing to give it a try.
Aware that everything follows the dollar, you ran the numbers:
At a 3% tax on your gross income, you will pay ~$2250/year, Co-pays will be
negligible. There will be no deductibles or coinsurance. $2250/year
Currently, you pay ~$2200/year in Medicare premiums. Your Medicare
supplement costs ~$3350/year. Some co-pays and deductibles apply.
$5500/year plus.
Thinking you may want to opt out of USHCS and purchase commercial insurance, you investigated an HMO (cheapest) Silver (cheaper) plan for a 64-year-old male (no data was available for age 75 in Florida): $1500/month; $9500 deductible; $10,150 annual out of pocket max. ꟷ certain to be higher for age 75
$18,000/year plus, plus, plus. Never mind.
Alert: should you require domiciliary care, your medical care will be provided;
however, you (personally, estate, family; etc.) will be responsible for room and
board charges (or this may someday be subsidized by a yet to be created
separate U.S. Department of Housing and Urban Development process).
Anticipating first steps, you had your personal health history available and had your
laptop and mobile phone charged and ready to go.
With some fear and trepidation, you mustered courage and went online with the USHCS Public Health Artificial Intelligence Center.
You were rapidly connected with and introduced to a kind, patient, respectful chatbot (who you named Chatbot Osler and who called you, at your request, Czar Dr. Mike).
Chatbot Osler oriented you to the USHCS big picture:
Welcome to The United States Health Care System (USHCS).
The USHSC is funded as infrastructure by the United States Treasury.
As an eligible resident, your basic (there will be some exclusions) health care will
be covered from cradle to grave.
Your care will be supervised by a Primary Care Team appropriate to your
age/gender/predominant conditions.
Your specialty care will be addressed by qualified specialist teams.
To maximize efficiency, you will be required to invest time and effort with a
chatbot to prepare you for efficient care.
Should you move or travel in the United States, your care will travel with you.
Should you travel beyond our borders, you may purchase affordable,
supplemental travel insurance.
Should you require long-term domiciliary care, your medical care will be
provided but you will be responsible for room and board charges.
You are free to seek and fund fee-for-service care. The USHCS will not be
responsible for any resultant charges.
Your regional USHCS is administrated by the ascendant, highly-rated (quality and safety) and highly-regarded (customer satisfaction) Boca Ciega Bay Health
System (the Boca Ciega Bay Health System, in fact, serves as the national
paradigm for USHCS regional care).
In short order, Chatbot Osler and you had populated your (very personal and unique)
medical record to include personal identifiers; health care surrogate(s); allergies and
implants; preventive care and immunizations; active medical problems; resolved
medical problems; medications (including supplements); family history; and personal physicians.
Chatbot Osler assisted you to explore and articulate your (very personal and unique)
health care advance directives and encouraged you to share them with your health care surrogate(s) ꟷ draft letters were prepared for your convenience.
Based upon your location and personal preferences, Chatbot Osler assisted you
choose/identify your Primary Care Team (you were delighted to be able to choose your current superb internist/geriatrician).
Based upon your location and personal preferences, Chatbot Osler assisted you
choose/identify your preferred participating regional hospital, participating pharmacy and participating urgent care.
Chatbot Osler congratulated you on your dedication to keep your colon cancer
screening, prostate health and immunizations up to date. He educated (nagged you a bit) you regarding the risk/benefits of your overdue influenza shot.
Then, at closure, Chatbot Osler took you through some basic considerations:
Your USHCS ID username (CzarMikeMD#007) and password
(BondJamesBond#007);
Privacy considerations;
What to do in an emergency;
How to approach anticipated care;
How to escalate your care to a higher level beyond ‘Better Angel’ Chatbot Osler;
and
Your scheduled semi-annual visit with your primary care team.
Dr. Mike, you have to admit that as an academic and clinical physician; a health care
administrator; and a LIOM-C (certified legend in own mind), you are impressed. This all made sense and went very well. You are now a full-fledged registered USHCS client/patient ꟷ enjoy the ride.
Respectfully submitted with fondest personal regards,
Dr. Mike
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
104. My (Unique and Very Personal) United States Health Care ꟷGetting Started
(more to follow)
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