IX. Fixing United States’ Health Careꟷ A Charismatic Story
- T Michael White MD FACP
- 3 hours ago
- 24 min read
The United States Health Care System
(USHCS) Created
Common Sense II
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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IX. Fixing United States’ Health Careꟷ A Charismatic Story
“Q: the most powerful force in the universe.
A: a charismatic story”
Albert Einstein
Esteemed Executives, hello.
For over two years, I have been on a lonely journey to analyze our country’s health care concerns and then synthesize a solution for United States Health Care:
First, I discussed issues with national experts:
Then, I explored my thoughts in: Fixing US Health Care --- Letters to the File;
and finally,
I proffer a solution in a pamphlet: The United States Health Care System
Created --- Common Sense II which I, in part, share with you today.
This pamphlet makes the case that the year 2025 exposed United States health care for what it is ꟷ 1) a cataclysmic, catastrophic, chaotic hot mess that 2) must be addressed by the creation of an ascendant, enlightened, planned health care system as infrastructure (like air travel, bridges, the grid, highways, the internet and ports):
that provides citizens universal access to affordable, basic/necessary, compassionate ꟷ safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP);
that enables, advances and protects personal (career education, food, housing and
retirement securities; and
that enables, advances and protects the public (institutional, community, economy and national securities) good.
But, who reads pamphlets?
What is required is a prescient, charismatic story that will ultimately be made into a
compelling, unnerving movie (like The China Syndrome). So, imagine that ‘the prestigious right people’ have been assembled (picture a State of the Union Address with you included) to witness an impassioned presentation by a humble, quixotic Dr. Don Quixote (visualize an impassioned, white-coated Jimmy Stewart in Mr. Smith goes to Washington in the lead role) and the following discourse unfolds…
OK, roll the tape…
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Fine Citizens, hello.
I stand before you as an ancient, wizened, relic of a canary in the coal mine, who is
embarrassed to observe that his decades of labor in health care have been a misdirected
misperception. When I entered medical school, I perceived that our fine country had an
implicit understanding (a contract if you will) with its fine citizens that health care was a right; and, in concert with that understanding, I, as a physician, would have the privilege and responsibility to strive, in some small way, to do important, meaningful work that would make a difference for those in need. My perception was in error.
If not forgivable, my misperception is understandable. I had had the good fortune to
grow up in what Yale Professor David Brooks describes as a well-ordered, secure social
container in which I was supported and nurtured by aligned nuclear family, extended family, school, church, city, state and country. In this secure container, I found confirming heroes in my life ꟷ the athlete, the coach, the doctor, the musician, the nurse, the parent and grandparent, the pharmacist, the police officer, the priest, the professor, the nun, the soldier, and the teacher. Growing from kid to adolescent to young adult, I intrinsically understood that, in turn, it would become my social duty to strive to position myself to, like them, do meaningful, important work that would make a difference ꟷ as the poly math Rabindranath Tagore would counsel:
“I slept and dreamt that life was joy.
I awoke and saw that life was service.
I acted and behold, service was joy.”
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As I speak to you today, my words are not about me and they are not yet about
privileged, comfortable you. But they are already about our near and dear, our progeny, our trailing generations, our neighbors and the majority of the fine citizens of these United States.
Therefore, I stand before you:
To convey that our United States’ health care non-system is a cataclysmic, catastrophic, chaotic hot mess (harsh words these but as you will see, not quite harsh enough); and
To covey that our decent, fine and virtuous country can and must immediately
implement dramatic change ꟷ change from chaos to a taxpayer funded planned health system infrastructure that will provide universal access to affordable, basic/necessary, compassionate ꟷ safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP).
What does our current health care hot mess look like?
Well, if you are independently wealthy; if you are protected by Medicare; if are blessed with good genes and good health (because you have chosen your ancestors wisely); if you have invested prudently in good habits and preventative care; and if you live in a community that offers great health care ꟷ and that is a hell of a lot if ifs ꟷ your health care feels like business class on a Emirates wide body. Well done you.
If you (with a spouse and a young family) are employed; if you have a good salary; if you have employer-sponsored health care insurance; if all in the family are healthy; and if you rarely need health care, you are now uncomfortably aware of increasingly
expensive, hard to manage, becoming worrisome premiums, co-pays, deductibles, co-insurance and the prospect of scary, astronomical out-of-pocket maximums (that reset each January 1st ). If the family remain hale and hardy, your health care feels like a very expensive, no frills, Allegiant flight.
However, for the same you, if significant illness or accident intervene and premiums, co-pays, deductibles, co-insurance and out-of-pocket maximums overwhelm, you find that your career, education, food, health, housing and retirement securities are in jeopardy and you confront The Great American Health Care Paradox ꟷ expensively insured when well and expensively uninsured when ill. When significant illness or accident intervene, your health care feels like you are preparing for an emergency landing in a losing altitude Piper Cub with iced-up wings.
If you are a small business owner trying to purchase health care, you find premiums,
deductibles and out of pocket maximums to be beyond your ken. Facing a no‑win
dilemma, you consider bankrupting insurance or going naked. In either case, although well, you comprehend the United States health care hot mess has placed you on a plane headed for a mountainside. If illness or accident intervene, your career, education, food, health, housing and retirement securities are in immediate jeopardy.
Should you be among our many uninsured citizens living paycheck to paycheck, your career, education, food, health, housing and retirement securities are already beyond potential jeopardy.
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Surely I have it wrong. Au contraire Mon ami. Some ready 2026 examples:
Young family; employer-sponsored health insurance:
annual premium $2,700;
in-network annual deductible $3,400; out-of-network $6,800
in-network out of pocket maximum $6,800; out-of-network $13,600
In an unfortunate year, this ‘insured’ family could face $9,500 ($16,300 ot-of-network)
in medical expenses plus the expense of excluded medical care.
Note: this all resets on January 1st .
A similar young family runs a small business (self-employed) and is purchasing market-based health insurance:
annual premium $35,000;
annual deductible $8,000;
annual out-of-pocket maximum $16,000
In an unfortunate year, this ‘insured’ family could face $51,000 in medical expenses plus
the expense of excluded medical care.
Note: this all resets on January 1st .
The New York Times provides this example (We Asked 300 Families About Their Health Care Insurance --- the Numbers Are Shocking) regarding a self-employed consultant in Virginia with a household income of $270,000:
annual premium $35,000
annual deductible $8,000
annual out-of-pocket maximum $16,000
In an unfortunate year, this ‘insured’ family could face $51,000 in medical expenses plus
the expense of excluded medical care.
Note: this all resets on January 1st.
An in-the-know corporate executive annual premium $5160; in/out network deductible $7,300/$14,700; in/out network out-of-pocket maximus ($9,100/$18,200) explains that his company pays 90% of employees premiums; that premium went up 23% for 2026; that no end is in sight; and that his and his company’s health care insurance calculus are unsustainable.
As bad as it has become for ‘insured,’ circumstances are unimaginable for the
uninsured. Not only are they not protected by out-of-pocket maximums, they are also charged full charges (while the ‘insured’ are charged deeply discounted fees negotiated by insurance companies). For example, for complex cardiac surgery, a patient was charged $900,0000, the insurance company recognized $90,000 and paid $85,000. An uninsured individual could be presented a non-discounted bill for the full $900,000.
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A few sidebar thoughts:
Significant illness or accident can quickly jeopardize personal (career education, food, housing and retirement) securities for most Americans;
The doctor age 68 with employer-sponsored health care insurance desires to retire but cannot afford to until his wife (age 62) qualifies for Medicare;
The doctor age 63 with employer-sponsored health care desires to retire but cannot
afford to until he qualifies for Medicare;
The young executive (hates his NYC job/girlfriend lives in LA) remains in his position
solely to maintain employer-sponsored health insurance.
After a simple appendectomy, an ‘insured’ waiter owed $10,000 which disrupted his
housing security (he lived for a time in his car) and impacted his employment.
Doctors facing “unremitting, bureaucratic insurance bullshit (technical term)” that
indiscriminately negatively impacts patients, describe burnout, depression and intention to leave the practice of medicine.
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Let me wax hypothetical for a moment (as a banker, I am a good doctor) ꟷ if the above
New York Times described consultant desires a mortgage:
income ($270,000) is in order;
down payment is in order;
monthly expenses are in order; however,
bank becomes aware that for two years in a row he has faced his health care out-of-
pocket maximums ($51,000 X 2 = $102,000)
Will the bank request and review health care insurance information? Will the couple be required to have medical exams? Will the bank lend? If not, how does this scary, not
uncommon anecdote impact the nation’s (65%) homeowners/sellers and home buyers; and how does it impact our nation’s economy?
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Let us come up for air for a moment and consider the two faces of American health care-our health care Ying and Yang. The Yang: if the above consultant presented to an emergency room, well-trained ‘Better Angels’ will step up with expertise and courage and provide safe, timely, effective, compassionate, patient-centered care; and the Ying: although ‘insured’, he may not be able to pay the freight.
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So, how did we get to this place where so many citizens do not have access to
affordable, basic/necessary, compassionate ꟷ safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP). I identify five enabling factors and the root cause:
Enabling Factor #1: the current status of United states health care demonstrates our
fine, rich, virtuous country has lost its way. Common decency has become uncommon. Confidence in our Clergy, Diplomates, Educators, Economists, Finance Professionals, Health Professionals, Law Enforcement, Justices, Military, Representatives and Senators, Scientists and Truth is being systematically undermined. In the process, the worth of a life is being devalued.
Enabling Factor #2: over time, the leadership of our fine country has determined that
the words “that all men are created equal, that they are endowed by their Creator with certain Unalienable Rights, that among these are Life, Liberty and the Pursuit of
Happiness” are merely aspirational. Unless facing existential national crisis (like a Pearl Harbor), leadership now holds each of us is all alone and very much on our own to aspire to a good life. For our health and well-being, they advise Carpe Diem and caution Caveat Emptor.
Enabling Factor #3: in violation of every industrial engineering quality and continuous quality improvement principle, United States health care is, from its beginnings, a leaderless, unplanned, non-system that has predictably evolved into an unsustainable hot mess ꟷ proving again that W Edwards Deming’s tenet, “Every system is perfectly designed to get the results it gets,” holds true.
Enabling Factor #4: the primary objective of heath care ꟷ universal access to affordable, basic/necessary, compassionate ꟷ safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP) ꟷ has been supplanted by profit as the primary goal. This capitalistic slippery slope fosters a leaderless culture that enables abuse, bureaucracy, duplication, fraud, greed, inattention and waste and results in inefficient, unaffordable health care.
Enabling Factor #5: a new beast now roams the land ꟷ unqualified politicians are finding personal and professional advantage in actively undermining the public’s trust in our country’s world-class public health expertise, evidence-based medical science and the ‘Better Angel’ practitioners who serve us so well each day. That predictable downstream suffering and death will surely come worries them not.
And now, The Root Cause. Simply, health care has been misclassified in our United
States capitalistic society as a commodity when, in fact, it is critical infrastructure (like air travel, bridges, the grid, highways, the internet and ports) that enables, advances and protects 1) personal (career education, food, housing and retirement) securities and 2) the public (institutional, community, economy and national securities) good.
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There is general agreement that our health care non-system is a hot mess. And that is where the conversation generally ends ꟷ “Houston, we have a problem.” I, your proudly
humble, quixotic Dr. Don Quixote, step forward with a solution: The United States Health Care System (USHCS). Consider the contract…
VI. The (Ascendant) 2026 United States Health Care System (USHCS) Contract
“We have it in our power to begin the world over again.”
Thomas Paine
If the previous chapter (V. The (Indefensible) 2025 United States Health Care Non-
System Contract) proffers an indefensible and unsingable contract between United States citizens and a United States health care non-system (and it does), then what would a reasonable United States health care system approximate? Beginning our health care world anew…
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The (Ascendant) 2026 United States Health Care System (USHCS) Contract
July 4th
Fine Citizen of These United States
Greetings.
“We're all in a social contract.
Whether we like it or not, we live in each other’s good graces”.
John Popper
To preserve the career, education, food, health, housing and retirement securities of
our citizens and advance the security of our institutions, communities, national
economy and our nation, our fine United States has designed and implemented, as
infrastructure: The United States Health Care System (USHCS).
This infrastructure is supported by your personal and by corporate tax dollars.
Remembering Thomas Paine (“What we obtain too cheap, we esteem too
lightly.”), we must each pay our way.
Careful design will 1) eliminate the prevalent health care culture of abuse,
bureaucracy, duplication, fraud, greed, inattention and waste that provides
leaderless, inefficient, unaffordable health care. Pricing, technology and
administrative costs will be addressed; and 2) provide each citizen access to
affordable, basic/necessary, compassionate ꟷ safe, timely, efficient, effective,
equitable/just, patient-centered care (ABC-STEEEP).
The United States Health Care System (USHCS) is administered by the United
States Health Care System Administration (USHCSA). The USHCA incorporates
the following expertise:
Artificial Intelligence
Business Administration
Customer and Employee Satisfaction
Cyber Security
Ethics:
Covered Services
End of Fife Issues
Technology
Finance
Medical School and Graduate Medical Education
Medical Literacy
Nurse and Support Staff
Physician and Physician-Extender
Public Health
Safety and Harms Prevention and Adjudication
Your signature below signifies that you understand and agee to the following regarding your (ascendant) 2026 United States Health Care System (USHCS) Contract. To assist you with a comprehensive understanding, please leisurely chat with Chatbot ‘Wisdom’ at USHCS.com/FAQs. Chatbot ‘Wisdom’ is prepared to patiently clarify any concerns that you may have.
The United States Health Care System (USHCS) is tax-supported infrastructure that
provides each citizen with universal access to affordable, basic/necessary,
compassionate ꟷ safe, timely, efficient, effective, equitable/just, patient-cented
care (ABC-STEEEP). It is supported by the United States Treasury. It is administered
by the United States Health Care System Administration (USHCSA). All clinical
provider claims are adjudicated by the USHCSA.
The United States Health Care System (USHCS) provides all citizens access to affordable, basic/necessary, compassionate ꟷ safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP). With the creation of the USHCS, most employers will cease offering employer-sponsored health care insurance. Medicare, Medicaid, the Veterans Administration and Congressional health care will be sunsetted ꟷ as the Canadians are proud to say, “the process is the same for the janitor and the judge.” A separate health care system will be run by the Pentagon for active military. Insurance companies may continue to offer private health care insurance policies for those who desire an alternative system of care.
Each citizen will voluntarily choose to join The United States Health Care System
(USHCS) which stands at the ready to serve all. Having contributed their taxes in
support, it is anticipated that most citizens will at some point in time take advantage of and utilize their USHCS benefits.
The United States Health Care System (USHCS) is a single payer (The United States
Treasury/United States Health Care System Administration) system. Care is provided by regional health care systems that have been selected on the basis of their proven ability to offer Health Care Value where value equates to quality and safety divided by cost (Q/S ÷ $). Depending upon populations, a regional system may serve cities, counties, states or regions of the country.
Your personal regional (33756) United States Health Care System is administered by the ascendant Boca Ciega Bay Health Care System that meets the following stringent United States Health Care System (USHCS) requirements:
Not for profit;
Fiscally sound;
Commands public health, medical education and medical ethics expertise;
Manifests computer science and cybersecurity proficiency;
Has sponsored an ascendant, successful, nationally recognized 5-Star rated
Medicare Advantage Plan:
That provides public health care, primary care (including behavioral,
obstetric and pediatric care), urgent care, emergency care; specialty and
sub-specialty care; home care; hospice care and prescription plan.
This I seamlessly connected with quaternary care ꟷ the General Tampa
University Center.
That proffers external regulatory-body evidence (for example, The Joint
Commission) of consistent provision of compassionate, safe, timely,
efficient, effective. equitable/just, patient-centered care (C-STEEEP);
That proffers external regulatory-body evidence (for example, Leapfrog
Hospital Safety Grade) of superb clinical, quality and safety, and patient
and provider (clinician) satisfaction scores;
That will participate in a national USHCSA process to identify, address,
adjudicate and compensate patients who have been avoidably harmed;
and
That passes an ongoing stringent USHCS forensic auditing process that
identifies ethical fiscal practices that prevent duplication of services,
fraud and abuse.
Your Boca Ciega Bay Health Care System meets or exceeds all requirements (and
in fact, serves as a national paradigm for USHCS regional health care systems). Your
Boca Ciega Bay Health Care System serves Florida’s Hillsboro, Pasco and Pinellas
Counties.
The United States Health Care System (USHCS) addresses (ABC-STEEEP). It does not address long-term domiciliary considerations (i.e., housing/room and board).
The United States Health Care System (USHCS) is supported by personal and corporate income taxes and is funded by the United States Treasury. The USHCS is required by legislation to function deficit free. Paraphrasing Thomas Paine: Rather than “running the next generation into debt, we ought to do the work of it; otherwise, we use them meanly and pitifully.”
The United States Health Care System (USHCS) is designed to protect each citizen from devastating health care bills that 1) jeopardize personal (education, food, health, housing and retirement) securities; and 2) threaten institutional (hospital), community, economy and national securities.
By signing below, you will voluntarily enroll in the United States Health Care System
(USHCS). It is ready (cradle to grave) to serve you. Importantly, once enrolled, you are not required to use it. Importantly, although not ideal, you may enroll at your first
requirement for emergent care.
If you desire to purchase additional health care insurance (or otherwise fund your
personal health care) you are free to do so. For clarification: 1) the United States Health Care System (USHCS) will not be responsible for any charges incurred outside of the system; and 2) even if you choose not to utilize the USHCS your tax dollars will continue to support the United States Health Care System (USHCS)
How does the United States Health Care System (USHCS) work? Basically
Should you perceive a medical emergency, always immediately call 911.
Elementary and remedial education programs will begin to arm each citizen with requisite literacy and computer skills to enable interface with the USHCS.
The United States Health Care System Administration (USHCSA) defined covered necessary care ꟷ care that is covered by the United States Health Care System (USHCS). In large part, necessary care approximates care formerly covered by Medicare.
From day one you have access to affordable, basic/necessary, compassionate, safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP).
Your coverage is portable throughout the United States and Territories.
Recognizing no man/woman can be an island, depending on your personal
circumstance (age, computer literacy, education, hearing, language, vision, etc.) you may, from time to time, need support from significant others (family, friends, etc.) to take full advantage of your United States Health Care System (USHCS) benefit.
As a first order of business, you will choose your Primary Care Team from a list ꟷa team led by professionals prepared to efficiently address your age, gender and chronic conditions. Your Primary Care Team leadership is specifically trained in primary care and public health population management.
Your primary computer/phone contact will be (per your choice) ‘Osler’ (a male voice), ‘Nightingale’ (a female voice) or ‘Robot’ (an electronic voice) ꟷ who will function as your caring, expert, personable USHCS Artificial Intelligence (AI) Primary Care Team 24/7/365 starting point. This artificial intelligence resource will efficiently assist you to: 1) longitudinally organize and manage your care; and 2) begin to address your acute care needs (remember in a perceived medical emergency always immediately call 911).
Your vital signs (temperature, respiration rate, heart rate, pulse oxygen, blood sugar and weight will be readily monitored electronically. This will provide powerful immediate clinical information in real-time and (diminish the need for many routine office visits).
If you do not have access to phones or computers, local pharmacy-based public resources will provide privacy, phones and computers for you to schedule at your convenience.
Your chosen age, gender and chronic condition appropriate physician-directed Primary Care Team will serve as your USHCS gatekeeper. With your USHCS AI support, your Primary Care Team will compassionately, efficiently and effectively:
Maintain your up-to-date, accurate personal medical record;
Manage your longitudinal care including public health recommendations
(for example, vaccinations) and cancer detection (for example, breast,
colon and prostate screening).
Address your acute care concerns and triage your care (as appropriate) to
virtual, Primary Care Team office, urgent care, emergency medicine;
hospital; specialist consultation; home care; and/or hospice care.
Prepare you to efficiently interface with your Primary Care Team and
consultants.
With USHCS AI pharmacy support, manage your medications avoiding
duplication, polypharmacy and drug/drug interactions.
Assist you to participate in activities (diet, exercise, etc.) that will advance
your well-being.
Assist you (with AI support) to interface with an extensive medical library
(supported by the Cleveland Clinic and the Mayo Clinic)
Continuously educate you regarding (specific to you) health care issues.
Many interventions that have traditionally required physical office visits
will be addressed efficiently and effectively through convenient, efficient,
effective, real-time virtual interactions.
As mentioned, each patient will be assigned to an appropriate Primary Care
Team. Patients with complex chronic conditions (for example, cardiology,
endocrinology, oncology, nephrology, neurology, rheumatology) that dominate
their care needs will be assigned to a Primary Care Team that has advanced
expertise in addressing the longitudinal care of their specific chronic condition.
Beyond taxes, you may have some out-of-pocket expenses:
There will be no premiums, deductibles or co-insurance;
To ensure judicious/thoughtful use of services on your part, certain
services (for example, urgent care, emergency room) will require a
modest co-pay. If you are referred by your Primary Care Team, there will
be no co-pay:
USHCS basic dental, hearing and vision insurance is provided. You may
encounter charges for additional complex care;
While your USHCS coverage is portable throughout the United States and
Territories, you may choose to purchase, for a modest fee, supplemental
USHCS travel insurance to cover emergency care when you venture
beyond prescribed borders.
You will encounter out-of-pocket expenses if you:
Independently engage treatments outside of the United States
Health Care System;
Independently engage treatments beyond the scope of the United
States Health Care System;
Independently engage in care not authorized by your Primary
Care Team and engaged consultants; and/or…
Insist on care which, after careful expert ethical review, is deemed
unnecessary and/or futile.
As previously mentioned, you may purchase private insurance for or
otherwise fund care outside of the United States Health Care System
(USHCS).
As you enroll in the USHCS you are being made aware and agree:
You are entitled to enroll in the USHCS. Your health care system is not a right ꟷ
as infrastructure (like highways), it is a privilege for you to appropriately utilize to
enhance your well-being.
Your privilege is accompanied by a responsibility for you to actively participate in preserving your health and facilitating your care. By signing below, you are
agreeing to consider your health care as your job #1 ꟷ a job that requires you to
be dedicated to being informed about and involved in your health care.
It is your responsibility to protect your personal identifiers (username and
password; etc.) Sophisticated security systems are in place to detect
inappropriate usage. Identified inappropriate usage will be prosecuted to the
full extent of the law.
Sophisticated security systems are in place to detect patient, health system or
provider (clinician) fraud and abuse. Identified fraud and abuse will be
prosecuted to the full extent of the law.
Importantly, habitual noncompliance with care on your part will be investigated
and measures to ensure compliance will be designed and implemented. In the
event of habitual noncompliance, you may be assigned to a Primary Care Team
with expertise in such matters. If, despite best efforts, inveterate, habitual
noncompliance persists, in rare circumstances, persistent abuse of privilege will
be considered as grounds for dismissal from the United States Health Care
System (USHCS). You will have rights and there is a process to challenge your
dismissal.
This brings us to your signature. The United States Health Care System (USHCS) looks forward to serving you….
Ideally, once you have agreed and submitted this signed contract, please, at
your convenience, begin to chat with your preferred expert Chatbot (Osler,
Nightingale or Robot) who will be pleased to hear from you and will efficiently
move your care forward.
However, your first encounter may be the result of an acute care (accident or
illness) need.. No worries ꟷ all will efficiently fall into place.
Signature:_________________________________ Date:______________
Respectfully submitted with fondest personal regards,
United States Leadership
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After review, this contract 1) provides universal access to affordable, basic/necessary, compassionate ꟷ safe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP) as taxpayer funded infrastructure; and 2) ensures both personal career, education, food, health, housing and retirement securities and the securities of our institutions, communities, national economy and our nation.
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VII. My Perfect Health Care 2025 and 2026
“Life is strong and fragile. It's a paradox...
It's both things, like quantum physics:
It's a particle and a wave at the same time.
It all exists all together.”
Joan Jett
In 2025, I had perfect health care. Protected by 1) a 5-Star Medicare Advantage Plan;
and 2) adequate personal resources to address quite reasonable out-of-pocket expenses; and armed with 3) a brilliant Primary Care/Geriatric personal physician who is dedicated to my Affordable, Basic/Necessary, Compassionate ꟷ Safe, Timely, Efficient, Effective, Equitable/Just, Patient-Centered Care (ABC-STEEEP); 4) living in a region that offers superb health care; and 5) (as a doctor) having a good idea of how the system works (or how to work the system), I sat comfortably in the United States’ 2025 catbird health care seat.
Yet, I felt paradoxically guilty with incontrovertible evidence that health care in our country is an inequitable, chaotic, catastrophic hot mess of a non-system that requires a restart as planned infrastructure. Guilt trumping complacency, I resigned myself to anxiously participate in a new planned paradigm of care ꟷ The United States Health Care System (USHCS)ꟷ a planned system that would provide universal access to ABC-STEEEP.
Truth: I was anxiously uneasy to be confronted with this new paradigm ꟷ this Unites
States Health Care System (USHCS). Cutting to the chase ꟷ the new deal: 1) my taxes will go up; 2) my Medicare expenses will disappear; 3) millions of citizens will have access to ABC-STEEEP; 4) an unplanned, leaderless, chaotic, cataclysmic non-system ꟷ that, because of a culture of abuse, bureaucracy, duplication, fraud, greed, inattention and waste, offers unaffordable, inefficient health care ꟷ will be replaced; and 5) I can (on my own dime) access care outside the USHCS if I so desire (having few dimes for health care, I probably won’t).
So, anxious and uneasy, I jumped in. My experience to date with the Boca Ciega Bay
Health Care System…
I was delighted to be able to choose my personal physician’s Primary Care Team;
I was heartened to find that my primary care/geriatric physician, my cardiologist, my
dermatologist, my gastroenterologist and my urologist all remain available within the USHCS. Although a plastic surgeon and a cataract surgeon have not yet chosen to join (they yet may) the USHCS, many alternatives are available.
I was pleasantly surprised and pleased to understand that General Tampa University
Medical Center provided quaternary care (trauma, transplant, complex surgery, etc.) to Boca Ciega Bay Health Care System patients (like me). In addition, I was informed that, if rare circumstances require, referral to national centers of excellence (Cleveland Clinic/Mayo Clinic) can be arranged.
My new BFF (best friend forever) ‘Osler’ (my AI (artificial intelligence) connection to my Primary Care Team) and I get along swimmingly:
‘Osler” has ensured that my username, password and contact information are in
order.
'Osler’ has been helpful in organizing my accurate, legible and up to date
personal medical record. It includes…
My personal identifiers and contact information;
My advanced directives;
My health care surrogates and their contact information;
My allergies;
My active medical problems;
My prescription and over-the-counter medications;
My health maintenance (immunizations and cancer screening)
information;
My past medical history;
My family history;
My physicians and their contact information;
My upcoming scheduled appointments; and
Links to my most recent (2 years) reports (cardiology; lab; pathology; and
radiology)
This accurate, legible and up to date information is immediately available at any potential point of care within the system. It will be automatically updated in real time. This is especially important if/when unanticipated, acute problems arise (for example, a visit to an out-of-state emergency department).
‘Osler” helped me prepare for my visit with my Primary Care Team:
Vital signs;
Pre-visit blood work;
Well-articulated (‘Osler’ has a way with words) symptoms that I wish to
discuss;
Well-articulated concerns that I wish to discuss;
Referral to educational resources so I may better understand my
conditions and symptoms as I prepare fro my visit.
Provided ‘Osler’s pre-work, my visit proved most efficient for both my
(very busy) physician’s team and for me.
All my issues were addressed;
All my immunizations and cancer screenings were deemed up to
date;
My exam included skin cancer, visual acuity and glaucoma
screens;
My medications were reviewed, adjusted and renewed;
I was judged to be stable and doing well;
I was scheduled to have vital signs and blood work to be reviewed
with ‘Osler’ in 6 months;
I was directed to maintain my annual dermatology and urology
specialist visit;
I was (happily) scheduled to return to the office in 12 months (not
my routine 6 months);
I was counseled to call 911 immediately in emergency; and
I was encouraged to communicate with ‘Osler’ at any time.
(note for clarification: this new USHCS process had eliminated a traditional 6-
month office visit ꟷ uncomplicating my life and making my Primary Care Team
more efficient.)
Periodically, I heard from ‘Osler,’ Messages were polite: 1) please submit vital
signs (a blood pressure check); 2) please update your influenza vaccine; 3) please
refill your statin prescription; 4) happy birthday; 5) etc. All communications
were unobtrusive and welcome.
Stuff happens. While visiting family in Richmond, I developed significant flu-like
symptoms. After a brief chat with ‘Osler’ and a review of my vital signs, it was
decided that based on my symptoms, medical history and age that I should be
seen in a participating neighborhood urgent care (and not in an emergency
room). Locked and loaded with my totally portable medical records, the urgent
care ‘Better Angels’ were prepared to efficiently examine me, test me, and
(despite up-to-date COVID booster) diagnose COVID. Because ‘Osler’ (my
Primary Care team) referred me, my modest urgent care co-pay was waived. My
anti-viral prescription was filled at a neighborhood pharmacy without charge.
(note for clarification: powerfully bargaining for > 300 million Americans,
prescription drug prices have plummeted for all).
‘Osler’ assisted me prepare for my annual visit with my urologist:
Vital signs and up to date PSA in hand;
Well-articulated progressive symptoms that I wish to discuss;
Well-articulated concerns that I wish to discuss;
Review of my understanding of and compliance with my urology meds;
Provided my progressive symptoms, ‘Osler’ determined my urologist
would require a uroflowmetry to complete my exam. The simple teat was
scheduled at the urologist’s office an hour before my physician visit. My
urologist was pleased to have all critical information (and I was pleased to avoid
a return visit ꟷ efficient effective care).
(Dodging a bullet), I was judged stable and assigned a follow-up visit in
one year.
The basic/necessary dental (utilized), eye (utilized), and hearing (not yet needed)
coverages are greatly appreciated.
After review, within the USHCS my care has remained superb ꟷ improved
actually, in that it is patiently comprehensive, totally portable and more efficient and
effective.
My wife, who partners with ‘Nightingale’ and who has chosen a Primary Care
Team expert in women’s geriatric medicine, has had an identical salutary, efficient,
effective experience.
In summary, my anxieties proved unwarranted. My already superb care has
been enhanced. I feel my care is both more accessible and more personal. I perceive
that I am more empowered. I am, for sure, much better informed. My care is now
seamlessly portable and palpably more efficient. Importantly, I observe my ‘Better
Angels’ are unburdened by bureaucratic inefficiency and 1) are more effective, and 2)
are enjoying their profession (once again).
With the change, I had high anxiety about the finances. That anxiety too has proven to be unfounded. Here is the skinny:
My wife and I (and everyone else including corporations), before any deductions, pay a 4% USHCS tax to support this infrastructure.
For us, this is similar to our Medicare premiums, drug plan premiums,
supplemental insurance premiums and our out-of-pocket co-pays, deductibles,
and co-insurance.
Prescription drug costs are under control.
We now have sound, basic/necessary dental, eye and hearing coverage;
We do not (nor does anyone) face significant co-pays, deductibles, co-insurance
and out-of-pocket maxims;
We are confident that our basic/necessary medical care will be provided from
cradle to grave;
We realize that long term housing in our dotage will not be covered by the
United States Health Care System (USHCS).. Such housing must be addressed by another (non-medical) system ꟷ food for anxiety provoking, significant thought.
Importantly, our progeny/trailing generations (children and grandchildren) are
paying 4% taxes per year and are in a much better place. Thay have access to
ABS-STEEEP and have eliminated jeopardies to personal career, education, food, health, housing and retirement securities and have advanced institutional,
community and national securities.
The cost of care has been and is now becoming less of a mystery. In 2025, an elderly
(Medicare) neighbor had a rough year (a simple surgery and a second surgery to deal with complications of the first). In addition, he/she had his usual (primary, cardiology, dermatology, etc.) care. In January of 2026, he received a summary of his 2025 Medicare Medical and Hospital Claims (Part D prescription drugs are reported separately):
Amount providers have billed: $212,000;
Total cost (amount Medicare has approved): $30,000
Medicare’s share: $23,000
Patient’s share: $2000
My gob smacked curious neighbor asks: 1) $212,000? 2) How did $212,000
(mercifully) become $30,000? 3) How did $30,000 become $23,000? And 4) $2,000
equates to his co-pays and co-insurance (largely hospital days) to the penny.
So, we took the numbers to Boca Ciega Bay Health System Patient Advocate to
have the numbers crunched. This information was forthcoming:
Bad news: in 2025, best minds cannot explain the numbers; each insurance
company would, per contract, report different numbers; and self-pay (uninsured,
etc.) would confront different numbers ꟷ generally trending towards higher costs
that are billed and expected to be paid.
Good news: in 2026, USHCS reports will demonstrate amount billed; amount
paid; and amount owed by the individual (generally near zero). The self-pay will
be billed and expected to pay the same amount paid. The difference (generally
negligible) between amount billed and amount paid will reflect a USHCS audit of
the amount billed by the Boca Ciega Bay Health Care System.
Standardization of this process will educate consumers regarding the true cost of
their care; and 2) will significantly reduce opportunities for abuse, bureaucracy,
duplication, fraud, greed, inattention and waste.
(As an important benefit, uninsured (for example, foreigners) can intelligently
shop for elective care.)
******
As I, proudly humble, quixotic Dr. Don Quixote conclude, let me share just a few a
closing observations regarding our United States health Care System ((USHCS):
A senior citizen with severe Parkinson’s Disease has a Primary Care Team that has
expertise in caring for complex neurological conditions;
A child with Type I diabetes has a Primary Care Team that has expertise in complex
pediatric endocrine conditions;
A college student has a Primary Care Team that has expertise in student health;
An unwed mother has a Primary Care Team that has expertise in complex women’s
health;
A brilliant, budding entrepreneur has left his dead-end job and opened his own small
business.
Vaccination schedules are determined by public health expertise and compliance is
enhanced;
Homelessness has declined;
Bankers be happy; and
This all came to fruition because in 2025: 1) we collectively grasped the stakes ꟷ our
country’s health care is now undermining our personal, family, institutional, community and national securities ꟷ a Pearl Harbor was upon us; 2) we collectively remembered the power of the conscience, character and will of our virtuous American citizenry; and remembering 3) we collectively made the United States Health Care System (USHCS) happen.
******
And the director says, “Cut! It’s a wrap!!”
You may leave an anonymous comment without inserting username and email ꟷ please do. Please share your wisdom, insights and perceptions (your reality) about what I have right, have wrong and/or have omitted. I will be delighted to hear from you as this draft and subsequent chapters will be significantly enhanced.
Best regards, Dr. Mike