VIII. Annotated Bibliography
- Feb 2
- 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)
******
VIII. Annotated Bibliography
In a New York Times opinion article (We Asked 300 People About Health Care
Costs. The Numbers Are Shocking.) Tracie McMillan shares some real-life personal health care insurance numbers. They are both unimaginable and unmanageable. In 2026, you, your near and dear, and your fellow citizens now own numbers like this one:
Job: Attorney, private practice
Household income: $144,000
2026 monthly bill: $3,698.67 for 2 people, up from $1,785.72 in 2025
2026 premiums + maximum out-of-pocket cost: $61,984.04
Consistent with the concept: The Great American Health Care Paradox ꟷ
expensively ‘insured’ when healthy and uninsured if illness or accident intervene.
(note: out-of-pocket maximums reset each January 1st)
Writing for the Associate Press (The US is on the verge of losing its measles elimination status. Here’s why that matters), Devi Shastri reports.
"The problem has been years in the making, as fewer kids get routine vaccines
due to parental waivers, health care access issues and rampant disinformation. More recently, Trump administration health officials have questioned and sown doubt about the established safety of vaccines at an unprecedented level while also defunding local efforts to improve vaccination rates.”
(note: 90% without immunity will contract measles if unexposed)
In (Vaccines Are Helping Older People More Than We Knew), Paula Span observes that vaccines both do that whish is intended (prevent infections) and:
reduced risks of dementia following shingles, pneumococcal, Tdap and flu
vaccines;
reduced cardiovascular (heart attack and stroke) risk following flu shots;
reduced risk of developing long Covid and its damaging effects on physical and
mental health;
(note: hypotheses focus on preventing the inflammation that arises
when the immune system mobilizes to fight off an infection.)
In (Experts Question Denmark’s Vaccine Program as a Model for the U.S.),
international correspondents Amelia Nierenberg and Maya Tekeli report: 1) “The United States, a nation of 343 million people with a complex and overburdened health care system, is poised to adopt the childhood vaccine recommendations used in Denmark, a country of six million with universal health care. The decision has alarmed public health experts in both countries.” 2) Kristian G. Andersen, a Danish-American professor in the immunology and microbiology department at the Scripps Research Institute in California, said the United States already has one of the best standards for vaccine recommendations; and 3) “The United States is not the same as Denmark,” Dr. Jennifer B. Nuzzo, the director of the Pandemic Center at the Brown University School of Public Health, wrote in an email. “The U.S. doesn’t have guaranteed, free health care that ensures every pregnant woman and baby gets appropriate medical care on a regular schedule.”
(note: “Denmark is the outlier,” Dr. Andersen said. “Not the United States.”)
In (This Is the Damage Kennedy Has Done in Less Than a Year), opinion writer
Jeneen Interlandi observes:
“None of these changes are evidence-based. All of them run counter to what the
C.D.C.’s own experts (and most of the nation’s leading medical groups) have
advised. And all are likely to sow confusion, undermine public trust and
ultimately drive the nation’s vaccination rates down.”
“Changes to the federal Vaccine Injury Compensation Program could
also seriously undermine vaccine access. The program, which compensates
people who suffer rare side effects from certain vaccines, was established in 1988 after a tidal wave of lawsuits threatened to drive vaccine makers from the
American market. If Mr. Kennedy decides to exempt any shot that falls under the fuzzy rubric of “shared clinical decision making” from this program — and if
nobody stops him — vaccine makers may once again threaten to leave the U.S.
market.”
“Vaccines are a triumph of human ingenuity, modern medicine and public
health. With them, we have beaten back smallpox, chickenpox, yellow fever,
polio, measles, mumps, rubella, hepatitis B, Covid, meningitis and more. If Mr.
Kennedy continues to force the nation down the course he’s now set, we will be
left to explain to future generations how we came to abandon them.”
“In fact, if the U.S. public health system has one thing going for it relative to
other nations, it’s probably vaccines. As the C.D.C.’s own data indicates, routine
childhood vaccination has prevented hundreds of millions of illnesses and tens of millions of hospitalizations here. It has also saved half a trillion dollars in medical costs, a figure that jumps into the multitrillions once you factor in indirect, societal costs like lost productivity and lost wages.”
(note: under the political leadership of Robert F. Kennedy Jr., the U.S. Department of Health and Human Services (HHS) is eviscerating scientific
evidence-based medicine and is bringing back suffering and death.)
In (For Republicans, Trump’s Hands-Off Approach to Health Care Is a
Problem),correspondent Like Broadwater:
quotes, Senator Amy Klobuchar: “Instead of spending this week working on this,
or last week, he’s going off saying, ‘Affordability is a hoax.’ This is not a president
that’s coming to try to find any kind of a compromise or work with us on this,
and the American people see right through it.”
Observes: “For more than a decade, Mr. Trump has pledged to release a health
care reform plan. In 2019, he told ABC News that he had a “concept of the plan”
that would be released within two months. In 2024, he made a similar pledge.”
(note: in 2026 health care is only affordable for those protected by the substantial
wealth necessary to address massive premiums, deductibles, co-insurance and
out-of-pocket maximums if/when significant illness or accident intervene.)
Value-based Care Is Not the Answer Health Affairs 2026-01-23
In (Value-Based Payment And Managed Care Will Not Solve The Affordability Crisis)
Andrew M. Ryan, Hayden Rooke-Ley and Robert A. Berenson address the true costs pf health care unaffordability:
“By outsourcing the cost containment function, VBP programs fail to confront
the core drivers of spending: high prices, technology diffusion, and
administrative costs.
“First, much VBP fanfare revolves around prevention, particularly under the
Trump administration’s MAHA (Make American Healthy Again) agenda. Primary
care physicians, the theory goes, have the wrong incentives for preventive
medicine under fee-for-service. If they were at risk for health care costs, then
they’d be motivated to deliver better preventive care, not “sick care.” This
theory overlooks numerous compromising empirical realities: that prevention is
largely driven by non-medical factors outside of the control of physicians; that
medical and wellness prevention efforts have ambiguous net effects on spending (although nonetheless are worthy); that widespread churn means that clinicians who bear the costs of prevention efforts are unlikely to recoup the benefits; and that physicians, especially in primary care, are motivated by much more than pecuniary incentives. As a result, the VBP risk-contracting paradigm, in addition to imposing administrative burdens, actually constrains primary care by limiting investments to elusive short-term cost minimization.”
“Second, VBP misapprehends the key drivers of US health care costs. The
paradigmatic ACO—a group of providers jointly assuming total-cost of care risk to provide prevention, access, and care coordination—reduces costs by
restricting or limiting use of the health care: hospitalizations, readmissions,
post-acute stays, and overall physician visits. Yet, these are not the drivers of
excessive health care costs in the US, nor spending growth. In fact, patients in
the US have fewer physician visits, fewer hospitalizations, and shorter lengths of hospital stay than peer nations. We also have significantly fewer procedures
such as hip replacements, knee replacements, angioplasties, prostatectomies,
and cholecystectomies. Rather than use, sky-high US health care costs are
primarily driven by high and misvalued unit prices (in both Medicare and
commercial insurance), the diffusion of new technology, and high administrative costs.”
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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