VII. My Perfect Health Care 2025 and 2026

The United States Health Care System

(USHCS) Created

Common Sense II

T Michael White MD FACP

www.fixingushealthcare.com

The Realization of Universal Access to ABC-STEEEP

(Affordable, Basic, Compassionate - Safe, Timely, Efficient, Effective, Equitable/Just, Patient-Centered Care)

******

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…

1. I was delighted to be able to choose my personal physician’s Primary Care Team;

2. 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.

3. 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.

4. 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).

5. 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.

6. 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.)

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