V. The (Indefensible) 2025 United States Health Care Non-System Contract
- T Michael White MD FACP
- Jan 16
- 6 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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V. The (Indefensible) 2025 United States Health Care Non-System Contract
“We're all in a social contract.
Whether we like it or not, we live in each other’s good graces”.
John Popper
The average American with employer-sponsored health care insurance has a foggy
sense that they have health insurance that will cover them if/when significant illness or
accident intervene. At one point in time, this was basically true. Those days are gone. Now, when illness or accident intervene, despite significant employer contributions and personal premiums, an expensive process of co-pays, deductibles, co-insurance, and out-of-pocket maximums begins ꟷ and for many, ‘insured’ care becomes unaffordable. To clarify and diminish misperceptions, please consider what an honest, readable contract between our fine citizens and their health care insurance providers would actually looks like in 2025…
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The (Indefensible) 2025 United States Health Care Non-System Contract
July 4th
Fine Citizen of These United States
Greetings.
Living in these United States, we are each free to pursue life, liberty and happiness (as we each choose to define it). Along with career, education, excitement, food, housing, peace, relationships, wealth, etc., health care is on the list of potential happiness considerations. To each his own. While giving you every encouragement to experience good health, your country reminds you that when it comes time to access health care, you are on your own. For clarification:
Cutting to the chase ꟷ despite outspending other comparable countries, health care in the United States is an unplanned non-system that, because of a culture of abuse, bureaucracy, duplication, fraud, greed, inattention and waste offers leaderless, inefficient, unaffordable health care.
Although all are aware that, in the interest of preserving deteriorating personal, family, institutional (hospitals), community, economy and national securities, our wealthy country must provide universal access to affordable, basic/necessary, compassionate ꟷsafe, timely, efficient, effective, equitable/just, patient-centered care (ABC-STEEEP) as planned infrastructure funded by personal and corporate taxes. It does not.
If (having chosen your ancestors well) you are gifted good health; if you respect your gift with salutary habits; if you fortuitously avoid serious illness and accident; if you have a coin or two in the bank; and if you have the wisdom to not live too long ꟷ good luck with all of that ꟷ you start with a health care leg up. Accolades.
Should you require significant care, you may reliably trust that fine, impeccably trained ‘Better Angels’ will step forward in your time of need with courage and expertise and provide you with world-class care. All good.
If you are well-employed and well-compensated and are basically healthy (in need of
little care), you will likely 1) have employer-sponsored health insurance; 2) be able to
afford your pricey premiums, co-pays, deductibles, co-insurance and out of pocket
maximums; and 3) (wrongly) perceive that you are insured.
Should you become significantly ill or injured, despite significant employer contributions and your personal premiums, your care may become excessively expensive due to premiums, co-pays, deductibles, co-insurance, and out-of-pocket maximums. If your medical event is brief, you may muddle through. However, if your need for care is prolonged, you may find the expense of your care places your career, education, food, health, housing and retirement securities in jeopardy (note: a leading cause of personal bankruptcy in our country is medical bills) ꟷ and you will conclude your sense of being insured is a grave misperception.
In combination, #5 and #6 above represent the 2025 Great American Health Care
Paradox ꟷ expensively ‘insured’ when healthy and uninsured when ill.
If you have a job that offers imperfect employer-sponsored health insurance, you must keep that job or find another job that offers imperfect employer-sponsored health insurance or become uninsured. There may be circumstances where you must choose to stay in an unacceptable job solely to maintain imperfect employer-sponsored health insurance.
You may be employed by a company that does not even offer imperfect employer-
sponsored health insurance (many companies will employ you part-time specifically to avoid a requirement to offer you expensive health insurance). Living paycheck to
paycheck:
You may purchase government subsidized basic health insurance, but as soon a significant illness or accident intervene, you will immediately be financially
overwhelmed by and unable to afford your premiums, co-pays, deductibles, co-
insurance and out-of-pocket maximums and you will immediately comprehend
that you are essentially uninsured. Your career, education, food, health, housing
and retirement securities will disintegrate. (Note: aforementioned government
subsidies have been eliminated ꟷ have a nice day.)
If you cannot even afford to purchase (now unavailable) subsidized health
insurance, as soon as a significant illness or accident intervenes, you will
immediately be financially overwhelmed by the expense of your care.
Some sad (sort of) good news: if you find yourself impoverished by the complexities of life, you may (or may not) qualify for Medicaid (qualifications are on a continuous
Congressional slippery slope). However, if you qualify for and successfully enroll in
Medicaid, government sponsored health care will provide you access to care (if you can find physicians that accept Medicaid).
Some good news: if you have had the wisdom to age into Medicare, you will have access to stable (for the moment at least) government sponsored care. However, if you live on a fixed income and do not have personal savings, you may find it a struggle to keep up with Medicare’s relatively reasonable premiums, co-pays, deductibles, co-insurance and out-of-pocket maximums.
Some better news: as a reward for service, Veterans may be eligible for well-deserved, well-earned government sponsored care. While many laud their care, others lament frustration with a ponderous health care system.
Some really good news: if you have first-rate private insurance (with or without
Medicare) and if you are protected by considerable personal wealth, you (able to
address premiums, co-pays, deductibles, co-insurance, and out-of-pocket maximums) are well-insured and you are among the minority of citizens positioned to enjoy a lifetime of superb, inefficient, inequitable, overly expensive world-class United States health care. Accolades.
Four cautionary caveats:
Premiums, co=pays, deductibles, co-insurance and out-of-pocket maximums are
ever increasing. Simultaneously, Medicare coverage is ever decreasing.
Stating the obvious ꟷ this honest, readable contract does not begin to address
the plight of the millions of our uninsured for whom the consequences (career,
education, food, health, housing and retirement securities) of a need for
significant care are unimaginable. Worse news ꟷ if you are self-pay (uninsured),
your clinical provider, hospital and pharmacy charges may be paradoxically (and
unfairly) significantly greater than the charges insurance companies and
Medicare pay.
This contract describes an indefensible national cataclysmic, chaotic,
dispassionate health care hot mess. In response, political leadership is, in real
time, eviscerating health care insurance subsidies; eligibility for Medicaid; public
health (for example vaccinations) safeguards; and confidence in our nation’s
world class medical expertise. In the words of experts, “political leadership is
bringing back suffering and death.”
Q: why don’t our health professionals (our ‘Better Angels’) fix this? A: they (high
income/low wealth) have it just as bad as you ꟷ if/when significant illness or
accident intervenes, their securities too are in jeopardy. And then worse, few
are in control of their own practices. They are not allowed by their employers to
see all comers or to even spend adequate time with patients they do see. Sadly,
they are increasingly disillusioned (burned out) by being unable to realize their
calling ꟷ providing affordable, basic/necessary, compassionate ꟷ safe, timely,
efficient, effective, equitable/just, patient-centered care (ABC-STEEEP).
My signature reflects that I have read the above: The (Indefensible) 20205 United
States Health Care Non-System Contract.
Signed: Dated:
Forewarned, you are forearmed. Stay Sharp.
United States Non-Leadership
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Articulated, this contract is sobering. If accurate (and it is ) our fine country’s health
care (non) system is a cataclysmic, chaotic, dispassionate hot mess Without a planned United States Health Care System (USHCS) as infrastructure, our fine citizens and their trailing generations face immediate peril if/when illness or accident intervene ꟷ peril that immediately disintegrates career, education, food, health, housing and retirement securities and places our downstream institutions, communities, national economy and national security in jeopardy.
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
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