Universal Access to Affordable Basic Health Care ꟷ The System
- T Michael White MD FACP
- May 9
- 13 min read
By T Michael White MD FACP
“As much as we need a prosperous economy,
we also need a prosperity of kindness and decency.” Caroline Kennedy
It is May 2025. I am approaching the onset of my 79th year. Through good fortune, serendipity and hard work, I have been gifted the privilege (and the responsibility) to address a career in Medicine. Why was I chosen to be blessed with this lifetime experience? I know not why. I only know that the honor and privilege has me obligated ꟷ that it is fair and just for me ꟷ to leave Medicine better than I found it.
I live on Florida’s Gulf Coast. Through more good fortune and serendipity (and a chagrined dearth of hard work), I enjoy age-adjusted good health. However, as I approach age eighty, I daily confront the usual and customary (and annoying) senior citizen litany of maladies (chasing blood pressure, cholesterol; aches and pains; etc.). For sure, more (cataracts, hips, knees, pacemakers, etc.) are on the way. No worries. Provided with 1) scientific advances, 2) the fine care provided by my brilliant and compassionate internist/geriatrician (my Better Angel) 3) the fine specialists that she refers me to and 3) the security and affordability of my 5-Star Medicare Advantage Plan, I will cruise through. All good.
Except it isn’t.
Millions of individuals in these fine United States do not have affordable access to even basic health care. There but for the grace of God go I (and mine). The reasons ꟷ clinical, economic, personal and political ꟷ are complex. Many say this circumstance is hopelessly irresolvable. I do not, cannot and will not accept that. Recognizing that perfect is the enemy of good, a partial solution ꟷ a good start ꟷ is readily available. I present it to you: Universal Access to Affordable Basic Health Care ꟷ The System (aka The System).
A Case Study I ꟷ Mr. John Q Public, Hometown, USA
Let me first introduce you to The System’s basic concepts through a case study Please imagine that Universal Access to Affordable Basic Health Care ꟷ The System is up and running (later I will take you to the why and how of its design and implementation). Mr. John Q Pubic is a 58-year-old gentleman who has been participating in The System since its inception. A few relevant facts:
He resides in Hometown, USA.
As an American citizen and/or permanent resident, he meets The System’s eligibility requirements.
He appreciates that The System is funded by the United States Treasury and that there will be no out-of-pocket costs for him should he enroll and fully participate.
His has enjoyed basic good health.
Since high school, despite hard work, he has never advanced far beyond living (modestly) paycheck to paycheck.
He has recently been laid off. Laid off, his life is a downward cascade. His modest savings are dwindling; his food and housing security are in jeopardy; and his health care insurance has been terminated. Purchasing health insurance is not a feasible consideration.
He does not qualify for Medicare (age) or Medicaid (modest savings, home ownership and recent income).
Fearing devastatingly expensive health care, he is highly motivated to make a concerted effort to take advantage of all that Universal Access to Affordable Basic Health Care ꟷ The System has to offer.
He has read, understood and voluntarily agreed to The System contract (we will soon get to that).
He clearly understands that higher level services beyond the basics offered by The System will be his responsibility. And, armed with that understanding, he is motivated to avoid/minimize the need for such care by maximizing his personal attention to wellness.
He has met username, email, mobile phone, password and security question requirements.
He meets language and literacy level requirements.
He has already frequently connected online with The System and has on occasion connected by phone. He has found interfacing with The System to be user friendly.
With the assistance of The System’s artificial intelligence and nurse-on-call functions, he has:
Completed his accurate and up-to-date personal medical record to include: his active problems; his major past problems; his allergies; his medications; and his physicians and their contact information.
Had his vital signs (weight, height, blood pressure, pulse and pulse oximetry) measured and recorded at a The System participating pharmacy.
As advised by The System, he is prepared to purchase reliable, just-in-case, over the counter, generic pain, temperature, diarrhea, constipation, and heartburn medications.
Identified his health care surrogates and then introduced them to their responsibilities.
Concisely articulated his health care desires and wishes (to himself and then) to his surrogates so that if he should lose the capacity to speak for himself they are prepared to move his desires and wishes forward.
Additionally, The System has actively advanced his access to affordable care by:
Recommending a participating regional free clinic that will monitor and treat his long-standing high blood pressure.
Having a participating pharmacist continuously review his prescription medications to ensure are the most effective and affordable available (as he is responsible for drug costs).
Reacting to information collected in his personal medical record, The System has provided him with relevant lifestyle (diet, exercise, habits, etc.) recommendations.
The System has informed him that assistance with immunizations, colon cancer and prostate cancer prevention and diabetes and lipid screening is available and has outlined how he may take advantage. To date, he has not utilized these services.
He has become adept at querying the system regarding specific health care information ꟷ for example, the diagnosis and treatment of hypertension? He has found the information educational and powerfully useful.
On occasion, he has queried the system on the behalf of family and friends ꟷ extending his affordable basic health care to others.
Importantly, he observes that The System process has been user friendly, easy to understand, helpful and has already made him an involved, informed and financially efficient health care consumer (patient).
A Case Study II ꟷ Accessing Acute Care
As our story unfolds, it has Mr. John Q Public traveling for a job interview in a neighboring state. He meticulously packs for the journey. This time, his access to Universal Access to Affordable Basic Health Care ꟷ The System travels with him (as it is portable throughout these fine United States).
His interview goes well. In the evening, as he prepares to leave for home the next morning, he becomes severely ill (fever, cough, headache, muscle aches, nausea and vomiting). From his hotel room.
He connects online to The System and is advised to rest, take fluids and acetaminophen as necessary for fever and pain.
Concerned by the severity of his symptoms, artificial intelligence immediately connects him with an on-call nurse.
Together they ascertain that, though quite ill, an ambulance is not required.
Together they decide he needs to make his way to a higher level of care (emergency room or urgent care). Because of the late hour, he is directed to a participating hospital’s emergency room.
The System alerts the emergency room that he is coming. His personal medical record is available for their review.
When he arrives, the professional staff (his Better Angels) efficiently determines that he has influenza, requires intravenous fluids for hydration and requires anti-viral therapy.
After observation, he is discharged with medication in hand.
The bad and good news:
(Bad) He understands that he is financially responsible for the emergency room visit, diagnosis and treatment.
(Good) As per The System policies, the hospital will charge for urgent care (not emergency room) services. These savings are significant.
(Bad and good) Within the month he receives a bill for modest, affordable usual and customary Medicare approved urgent care costs (not inflated urgent care or emergency room charges).
(Good) The participating hospital’s Social Service Professionals (as a function of The System) actively communicate with him to assist him (if necessary):
Find follow-up care.
Set up a payment schedule; and/or
Apply for Medicaid (if he qualifies, his emergency room care will be covered retrospectively).
Reemployed, he slowly pays off the reasonable charges for his wonderful acute care. Reemployed, he is reinsured. Despite being insured, given the realities of significant deductibles, co-pays and co-insurance, he maintains his relationship with The System for his basic health care ꟷ he envisions a lifetime cost-saving partnership.
With a job and health care insurance, and as a well-informed, fully engaged participant in The System (which he now utilizes for most of his care), he is poised to again begin to live happily ever after.
Case Study III ꟷ Emphasizing Basic Care
As you consider this Mr. John Q Public’s case study, I am confident you recognize The System’s limitations. For emphasis, please appreciate:
The federal government has designed and implemented Universal Access to Affordable Basic Health Care ꟷ The System. The word basic must be emphasized.
To participate:
One must meet eligibility requirements.
One participates voluntarily.
One must have computer and/or phone access.
One must have computer and/or phone literacy.
To benefit, one must rise to the responsibility of actively engaging with The System.
The System’s offered services, though basic, are relatively extensive and are offered without charge.
Regarding higher levels of care:
They are not offered/covered by The System.
Therefore, individuals are financially responsible for higher levels of care.
Individuals are encouraged to use participating urgent cares, hospitals and pharmacies as they:
Are connected with the individual’s personal medical record.
By The System design, minimize charges for higher levels of care.
Make Social Service Professionals available to assist individuals address follow-up care and navigate the expense of higher levels of care.
Most importantly and saying it plain, The System is imperfect. Despite the many advantages offered by The System, when significant higher levels of care (for example, care for an acute myocardial infarction) is required that care will be significantly expensive ꟷ an expense that may significantly impact the individual’s financial circumstances as Universal Access to Affordable Basic Health Care ꟷ The System does not insure against or provide access to affordable higher levels of care.
Enrolling in The System
At this juncture, having experienced The System via Mr. John Q Public’s case study, let us circle back to the beginning. Imagine that you are now voluntarily considering enrolling in Universal Access to Affordable Basic Health Care ꟷ The System. To enroll, you will consider the following document. If after review, you wish to enroll you will sign and submit the included contract:
******
The United States Treasury
Date
Dear Applicant,
Thank you for your interest in Universal Access to Affordable Basic Health Care ꟷ The System. Enrollment is straight forward and immediate. To proceed, please consider the following and, if appropriate for you, please sign and submit the Eligible Resident Contract below. (Note: as will become clear to you, you may disenroll at any time.)
Introduction
Ideally, our fine country would have a health care system that provides 24/7/365 comprehensive health care to all eligible residents. In 2025, for complex clinical, economic, personal, political and technological reasons, this goal is both unrealistic and unachievable. Therefore, to move our fine country’s health care forward, this Universal Access to Affordable Basic Health Care ꟷ The System has been created to provide eligible residents with 24/7/365 access to affordable basic health care.
The United States Treasury
To enable the creation of Universal Access to Affordable Basic Health Care ꟷ The System, The United States Treasury has:
Entered contracts with carefully selected participating hospitals and participating pharmacies*.
Entered a contract with Microsoft for the design and implementation of artificial intelligence supported online services.
Entered contracts with the Cleveland Clinic and the Mayo Clinic for access to their artificial intelligence supported patient medical libraries.
Entered a contract with AT&T for telephone services.
Established resident eligibility requirements.
Created a system to audit services purchased to ensure efficient and effective delivery of those services.
Recognized The System as infrastructure (akin to airports, bridges and highways) that is funded by the taxpayer supported general fund.
(* Selection criteria for participating hospitals and pharmacies have been rigorous. Each have been recognized as the sponsors of successful, efficient, effective 5-Star Medicare Advantage Plans. The selected hospitals and pharmacies have close working relationships. Their Administrations have agreed to enter into a contractual agreement with the United States Treasury. Their Administrations have been receptive to supporting the innovative design and implementation of The System. The selected institutions provide comprehensive tertiary-care services (including hospital, laboratory, emergency department and urgent care) within their catchment areas and they have close working relationships with institutions that provide quaternary-care (for example, oncology, transplantation and trauma) services. They have robust Information services expertise; robust social services expertise; health care research (clinical and financial) departments; and they maintain not-for-profit status.)
The Eligible Resident Contract
Eligible residents who wish to voluntarily participate in and take advantage of benefits provided by The System must read, agree to and abide by the following contract:
Universal Access to Affordable Basic Health Care ꟷ The System
Eligible Resident Contract
By signing below, I agree to abide by the following terms and conditions for participating in Universal Access to Affordable Basic Health Care ꟷ The System hereinafter referred to as The System.
I have reviewed frequently asked questions (FAQs) at www.TheSystemFAQs.com and I have chatted with The System professionals to successfully clarify any questions that I may have had.
All considerations will apply equally to my participating dependents that I may enroll.
My participation is voluntary.
I may disenroll at any time.
I must meet the eligibility requirements established by the United States Treasury.
I understand that The System provides only basic health care.
I understand that The System will always advise me to disconnect and contact 911 for emergencies.
I understand that, after an initial assessment, The System may advise me to seek higher (more complex) levels of care (for example, urgent care or emergency care) for which I will be clinically and financially responsible.
I understand that I am entering into a partnership in which my partner, The System, has expectations of me. To participate, I agree to:
Always communicate accurately.
Always communicate kindly and patiently.
Network, as needed, with my family, my friends and my community to enhance my access to The System.
Have an email address.
Create a unique username and a protected password and provide security questions and answers.
Protect my privacy (my password, etc.).
Have computer access to The System.
Have telephone access to The System.
Arrange access to basic over-the-counter health care aids (at my expense) to address common issues such as fever, pain, constipation, diarrhea, etc.
Partner with The System to:
Create my personal medical record.
Articulate my personal health care desires and wishes ꟷ my advanced directives.
Identify my personal health care surrogates.
Instruct/educate my personal health care surrogates regarding my personal health care desires and wishes.
Always consider seeking higher-level care when advised. Seeking such care will ultimately be my responsibility. I agree to use good judgement in this regard.
Not exploit The System (for example, manipulating rules, overloading resources, or misusing privileges). I am aware exploitation on my part will be identified and addressed. I am aware that such exploitation may place my The System eligibility in jeopardy.
If able, purchase and maintain health insurance in support of higher-level care.
If available, maintain my relationships with my fine longitudinal health care providers (for example, with my primary care physician).
I understand that The System provides basic healthcare to include:
Maintenance of privacy.
Creation and maintenance of my personal medical record.
Assistance with articulating my personal health care desires and wishes (my advanced directives); identifying my personal health care surrogates (those who may speak for me if I am incapacitated); and instructing and educating my personal health care surrogates regarding my health care desires and wishes.
Computer generated answers to my medical queries.
24/7/365 access to basic (artificial intelligence and physician supported) nurse chat/telephone clinical advice.
Education about immunizations, high blood pressure, diabetes, lipid disorders, pregnancy, breast cancer, colon cancer and prostate cancer.
Access to immunizations and screening for high blood pressure, diabetes, lipid disorders, pregnancy, breast cancer, colon cancer and prostate cancer.
Ongoing education regarding prevention consideration such as diet, exercise and intellectual, physical and social habits.
If necessary, immediate connection to 911, poison control and/or suicide hot line services.
The System services are provided at no cost to me.
Importantly, I understand that if I seek higher-level care at a participating The System facility:
I will receive care;
I will be financially responsible for reasonable (The System negotiated) usual and customary charges.
The participating hospital’s Social Service professionals will assist me find (if available) higher-level care alternatives (for example, Medicaid, free clinics, charity care, payment plans, etc.) that may make my care more affordable.
Importantly, I understand that if I seek care at non-participating facilities, many of The System benefits will not be available (pertain to my care) to me.
In summary, I understand the United States Government has established Universal Access to Affordable Basic Health Care ꟷ The System which is funded by the United States Treasury as infrastructure that provides basic health care to eligible residents who wish to participate. The goals and potential benefits of The System include: 24/7/365 access to basic care; enhanced basic medical care literacy; enhanced health care affordability; and enhanced wellness.
By signing below, I understand the elements of this contract and I voluntarily agree to enroll in Universal Access to Affordable Basic Health Care ꟷ The System and I agree to abide by the provisions outlined above.
_______________ _______________ ___________ ___________
Printed Name Signature Date of Birth Date
******
Conclusion: Universal Access to Affordable Basic Health Care - The System
As I conclude, allow me to harken back to my introduction. There I, a medical professional of advancing age, celebrated my perfect health care and grimly lamented the fact that millions of our co-residents in our fine United States do not have access to affordable basic health care. Rejecting the commonly held misperception that this complex clinical, economic, personal, political and technological circumstance is irresolvable, after a year of research and discussion (please review https://www.fixingushealthcare.com/) and just a few keystrokes, I have crafted an very sound (albeit imperfect) solution. As I come to closure, allow me to observe that the proposed Universal Access to Affordable Basic Health Care ꟷ The System:
Is not rocket science. It is just more important than rocket science.
Can readily be created.
Is efficient, effective and affordable.
Will immediately assist those like our very ill Mr. John Q Public ꟷ a young lady with morning sickness, a young mom with a sick infant, an athlete with a minor injury, or a gentleman with shortness of breath ꟷ to no longer feel they have been left alone.
Recognizing that perfect is the enemy of good #1: it imperfectly requires language, computer and/or phone competency. Some participants will need the assistance of family, friends and community to address these social (not medical) barriers to accessing care.
Recognizing that perfect is the enemy of good #2: the provisions of care are basic. If accident or illness require higher levels of care, they must be accessed in the current, traditional manner. For residents unprotected by the securities of significant personal wealth and robust insurance, massive expense may dramatically impact their financial circumstances ꟷ may dramatically impact basic life securities (educations, housing, nutrition, etc.).
After review, I recommend Universal Access to Affordable Basic Health Care ꟷ The System to you. I look forward to your comments ꟷ your insights, your perspectives, your wisdoms. Please find the energy to share your views ꟷ that which I have right, wrong or omitted.
Respectfully submitted,
T Michael White MD FACP
Bellair, Florida
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