108B. The Enabling Cataclysm ꟷ A Fiction?
- T Michael White MD FACP
- 24 minutes ago
- 6 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)
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108B. The Enabling Cataclysm ꟷ A Fiction?
“Cataclysm: a momentous and violent event
marked by overwhelming upheaval and demolition;
an event that brings great changes.”
Merriam Webster Dictionary
The WhiteHouse on the Belleair Bluff
Sunday, November 30, 2025
Dr. Mike,
A letter to the file…
In discussing the enabling legislation creating the United States Health Care System that provides eligible residents of our fine country with universal access to affordable, basic, compassionate, safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP), you intimated the genesis was a cataclysmic event. Remembering Einstein ꟷ “the most powerful force in the universe is a charismatic story,” please share what you know in that way.
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The United States Health Care System ꟷ The Enabling Cataclysm
By W Ryder Black MD
“Our revenge will be the laughter of our children.”
Bobby Sands
At its start, our fine country’s health care cataclysm was not a quake. It was not a slight tremor. At most, it was the imperceptible flapping of butterfly wings.
In his quiet way, the ancient, hoary, prehistoric doctor had had a fine clinical, academic and administrative career. Blessed with the powerful privilege to heal, he understood his responsibility and took it seriously. On balance, always striving to do his best for those (patents, families, institutions, staff and community) entrusted to him, he had done good.
Increasingly, he had become disappointed (critically alarmed really) with United States health care. The non-designed, non-planned, non-managed United States health care non- system had evolved into an unjust paradox in which some, protected by Medicare and personal wealth, received unparalleled, world class care, while others, in ever increasing numbers, could not access the most basic care.
Alarmed, he was uncertain as to how to impact necessary change. Flummoxed, he did what he was wont to do ꟷ he wrote an important, meaningful book that could make a
difference (that no one will ever read); and published it as a draft (Fixing United States Health Care ꟷ Letters to the File Part I. The Hot Mess; Part II. The Solution) on a website:
Despite his best efforts, an escalating flurry of health care non-system insults cascaded:
Patients with once robust employer-sponsored insurance found their premiums,
deductibles, co-insurance and-out-of-pocket maximums increasing to the point where if they were to have a significant accident or illness, they were essentially self-insured.
The paradox ꟷ expensively insured when well; uninsured when ill;
Despite subsidies, patients purchasing Affordable Care Act policies recognized a sham ꟷ premiums, deductibles, co-insurance and-out-of-pocket maximums were such that were they to have a significant accident or illness, they would be essentially self-insured. The paradox ꟷ expensively insured when well; uninsured when ill (yes there is a pattern here);
Sadly, those in poverty who had been protected by an imperfect Medicaid safety net
increasingly found their eligibility eroding; and then…
A new health care non-system beast arrived ꟷ unqualified individuals (politicians,
lawyers and fringe contrarian professionals) without necessary prerequisites began (for financial, personal and political gain) to undermine the world-envied, scientifically sound United States Public Health apparatus and place millions, long well protected, at risk.
Insults cascading, the ancient physician became impatiently compelled to advocate for immediate, dramatic change.
Confident that his concerns were increasingly well-articulated and observing that most, when confronted, agreed that there was cause for significant alarm, he still found himself soldiering on very much alone. He diagnosed three syndromes paralyzing community action: 1) some who perceive their care is just fine and is not in immediate jeopardy are relaxed ꟷ the I got mine syndrome; 2) some, well aware that the health care sky is falling, deeply alarmed but are overcome by a sense of futility ꟷ the nothing can be done syndrome; and 3) some, brutally disillusioned by the realization that our decent, kind, virtuous country would treat its fine citizens this way, are overcome with sadness ꟷ the broken-hearted syndrome. Unable to blast past these paralyses and rally support, the doctor quixotically soldiered on.
Then tragedy struck his idyllic community. Unqualified contrarians had systematically endeavored to undermine the safety and necessity of childhood vaccinations. Seriously underestimating disease and seriously overestimating the longevity of herd immunity, a predictable, pernicious measles epidemic struck. Avoidable deaths and unimaginable suffering ensued. The immunocompromised and elderly with waning immunity became collateral damage. Physicians (amazed at the ferocious manifest of long dormant measles) and hospital were overwhelmed. “Oh, the humanity!”
But the tragedy had implications beyond clinical considerations:
Employment was disrupted and for some, paycheck to paycheck means vanished;
School systems were in disarray. Education calendars were eviscerated;
Even for the ‘insured,’ insurmountable costs of care (co-pays, co-insurance, deductibles) placed education, finance, food, health, housing and transportation securities in jeopardy;
The region’s economy (churches, stores, restaurants, theatres and tourism) imploded; and
For the newly sentient, with measles as the canary in the mine, long quieted fears (of
smallpox, polio, rubella, etc.) seemed all too immediately real.
Predictably, the imposter experts ꟷ the posers ꟷ who had, without qualifications, fueled vaccine skepticism did not step forward to offer assistance; take responsibility; provide compensation; or begin to place the vaccine risk/benefit ratio into appropriate perspective. Inexplicably, they seemed unaware they may be held accountable for their imprudent and inaccurate, clinical advice ꟷ that bells may one day toll.
This is where the story-worth-telling begins. Knowing the cost of silence and the power of showing up, the ancient, hoary, prehistoric physician upped the ante. Fate found him seated on an uncomfortable folding chair at the White House gate. Wearing a white coat, carrying a stethoscope and displaying as sign ꟷ Universal Access to Health Care Now ꟷ he waved to the official motorcades passing by. They paid him no never mind. The press, however, was more curious.
Investigating his website https://www.fixingushealthcare.com/ and finding it well-
conceived, reporters found him dedicated, focused, articulate and persuasive. For them, his message rang true: 1) our fine country must immediately address a thoughtfully designed and implemented United States Health Care System 2) as infrastructure, 3) funded by personal and corporate taxes, 4) that provides our fine citizens with universal access to affordable, basic, compassionate, safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP). Importantly, beyond exposing the need, he outlined how it could, should and must be immediately done.
At a news conference, the President was asked about the physician protesting daily at his threshold. “I’ve seen him. He looks wacked out to me ꟷ like a village idiot. For me, it’s simple ꟷ if he wants to make difference, he should go see patients.”
Wrong answer. Game on.
In an onsite, typical, balanced Bret Baer interview, the doctor came across as an
avuncular, calm, caring, informed, pleasant professional ꟷ a Marcus Welby MD protesting at the White House gate. His message was crisp, clear and concise and something all could relate to. His website caught fire. A publisher stepped forward to print his book. A movie (Tom Hanks battling for the lead) was in the works. All good.
And then, the good doctor initiated the requisite health care cataclysm with a televised, precision-guided, bombshell that went viral. “I have the responsibility to leave my sacred profession better than when it was gifted to me. I now understand my words will not suffice. What can one man do? Having studied the Irish Troubles, tomorrow I will begin a hunger strike. It will continue until legislation is passed for a United States Health Care System that provides universal access to affordable, basic, compassionate, safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP); or, until, in a month or so, I perish ꟷ advocating for others to step up as I depart.”
The next day, scores of sign-carrying retired health care professionals, attired like he, sat at the White House gate on uncomfortable folding chairs and fasted with him. Each day, enormous crowds assembled in support. Almost immediately, similar scores of professionals and crowds gathered in unrelenting fasting vigils at governors’ mansions and senators’ and representatives’ abodes.
A happy ending ꟷ in time for the weak, failing physician to reverse his decline, the
legislation he proposed was enacted ꟷ The United States Health Care System. (1215 words)
WRBMD 2025
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Dr. Mike, you must ask yourself, is there truth in this fiction? Has your obligation to
leave your sacred profession better than when it was entrusted to you, become a personal, existential obligation? Important questions to ponder these. Pondering, it is helpful to remember Simone Weil, “Imagination and fiction make up more than three quarters of our real life.”
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 United States Health Care System ꟷ Enabling Legislation
103. The United States Health Care System ꟷ View From Space
104. My (Unique and Very Personal) United States Health Care ꟷ Getting Started
105. My Semi-annual Primary Care Team Visit
106. The United States Health Care System ꟷ My Contract
107. ‘Medicide’ ꟷ Failure to Make Whitefish Bay (A Fiction)
108A. Charley Price’s Prologue ꟷ We Must Start Anew
108B. The Enabling Cataclysm ꟷ A Fiction?
(more to follow)
