Fixing US Health Care: A Kelly Kelly Show Conversation

WTAN (106.1 FM or 1340 AM)

 Tan Talk - WTAN - AM 1340 - Clearwater, FL - Listen Online 

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

fixingushealthcare.com

Monday, February 24, 2025

Dear Mr. President, Honorable Members of Congress and Distinguished Staff and Fine Citizens,

The following is a script of a radio conversation addressing fixing US healthcare.  The program itself can be accessed at: 

• Tan Talk - WTAN - AM 1340 - Clearwater, FL - Listen Online 

• Facebook live at: https://www.facebook.com/thekellykellyshow;

• Live on YouTube at "Tan Talk Radio Network" by looking for The Kelly Kelly Show (link available after it airs);

• at internetradiopros.com/kellykelly as a podcast;

• or by listening to WTAN 106.1 FM or 1340 AM on the radio.

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Good afternoon Doug and Kelly Shannon Kelly.  Thank you for having the courage and expertise to conduct this important and meaningful weekly multi-media program.  Thank you for inviting me today.  Your invitation is important to me personally as this radio event has forced me to begin to synthesize my thoughts on an important topic: fixing US health care. 

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I find it helpful to preface my remarks with a quote that captures the spirit of what I hope to convey.  Today, I quote Caroline Kennedy…

“As much as we need a prosperous economy,

we also need a prosperity of kindness and decency.”

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Albert Einstein purportedly observed that the most powerful force in the universe is a charismatic story.  Let me start with a story.  A kid (perhaps yours or mine) graduates from a fine college with a marketable degree and is hired by a leading firm in The Metropolis.  Although the kid’s salary is handsome, because of big city rent, educational loans, car payments and health care premiums, disposable income is tight.  Savings are miniscule.  All is good, until a complicated case of acute appendicitis ensues.  Care is spectacular.  All good --- until deductibles, co-pays, and co-insurance come due.  Unbelievably, the wolf is at the door --- housing security, food security and credit rating are placed in jeopardy.  In retrospect, this insured kid is, for all practical purposes, uninsured.

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About six months ago, two of my colleagues and I, having had the privilege of wonderful careers as physicians, recognized that we have a responsibility to leave health care in these fine United States better than we found it.  The three of us go back a long way sharing training, clinical, scientific, teaching and leadership experiences.  Dr. Stephen F Hightower, an internist and geriatrician, resides in Rio Rancho, New Mexico.  Dr. Dana Kellis, an internist and critical care physician (with an MBA and PhD) resides in Farmington, Utah (towards the end of the program, we will hear from them both).  I, Dr. T Michael White, an internist, reside in Belleair, Florida.  In our own way, each of us brings academic, administrative and clinical leadership insights into assessing and fixing America’s health care.  Taking our responsibility to leave health care in a better place seriously,  we set up a website: www.fixingushealthcare.com/ and began a dialogue to better understand (to research) the status of health care in America.  We have learned a lot.  Importantly, I encourage your audience 1) to explore the website and 2) to share their insights and perspectives as we still have much to learn.  Again the website: www.fixingushealthcare.com/,

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Today, as we chat, we are having a crucial conversation.  Therefore, it is important for your audience to understand who is speaking.  For a lifetime, I have been positioned to experience healthcare from the perspective of the learner, the practicing physician, the teacher, the health care executive, the health care system board member, the quality/safety expert, the regulatory agency surveyor and, increasingly as I age, as the patient.  Over the years, I have written several relevant books on today’s subject including:  

• Unsafe to Safe --- An Impatient Proposal for Safe Patient-centered Care; and

• Affordable Basic Health Care for All --- An American Health Care System Charter

As we talk today, Drs. Hightower, Kellis and I are positioning to publish a work aimed at fixing US health care. 

After review, I encourage your audience to recognize I have earned some credibility as we explore this crucial conversation on the status of health care.   

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The concept fixing US health care suggests America’s health care is broken.  Here is how I would frame it…

Our American health care is a post-World War II non-system that has evolved without planning or guidance.  Happily, if we find ourselves in the right circumstance (right condition; right clinician; right insurance; and adequate savings) ꟷ and that is a lot of ifs ꟷ our care will be unarguably world class.  Sadly, too often, that now is not the case.  Increasingly, when significant illness intervenes, we find ourselves in a chaotic, unaffordable, unsustainable hot mess.  With a non-system that is unplanned and unguided (that is, a system that is leaderless), we are reaping the health care non-system that we have for decades sowed.

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So, Drs. Hightower, Kellis and I aspire to try to make a humble difference.  As we began our webpage, I articulated my personal aspirations:

1. To assist our fine United States to design and implement a continuously improving health care system that provides all access to compassionate, safe, timely, efficient, effective, equitable (just), patient-centered care (aka C-STEEEP). 

2. To celebrate our health care successes ꟷ and there are many.

3. To lament our health care failures ꟷ and there are many.

4. To participate in an iterative learning/teaching/learning cycle addressing the improvement of health care. 

5. To unfailing maintaining a decent, kind, respectful, professional tone (no finger pointing will be allowed as we all have contributed to the current dysfunctional non-system); and

6. To ultimately recommend a solution.

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Importantly, I personally receive perfect health care.  Therefore, I am positioned to speak up with no personal axe to grind.  How is it that in the midst of a health-care-hot-mess, I am the recipient of superb care?  On our website, I have written: Perfect Health Care — Yet Crushing Regret.  It reads…  

I am the beneficiary of perfect health care in these fine United States.  My outstanding care demonstrates the potential for health care in our country.  Sadly, my exceptional care is the exception.  Towards advancing the care of each citizen, let us explore my  circumstance in detail.  After consideration, my good fortune reflects knowledge, effort, support and a large dose of serendipity.  Let me enumerate the ways that have positioned me for fine care…

1. Through training and experience, I can define and then seek perfect health care ꟷ compassionate, safe, timely, efficient, effective, equitable (just), patient-centered care (C-STEEEP).

2. Having chosen my ancestors well, I have a genetic leg up on good health.

3. Through the insistence of my good spouse (Jackie), I follow a Mediterranean diet and exercise regularly. 

4. I have had the wisdom to live long enough to age into Medicare (and this factor is critical).

5. Thanks to social security and modest retirement income, my spouse and I have home, food and transportation security and we can afford our reasonable Medicare premiums and co-pays.

6. Upon Medicare eligibility, I did my homework:

   1. I chose to reside in a community noted for exceptional medical care.

   2. I selected a fine regional health care system’s 5-star Medicare Advantage Plan.

   3. I chose an option requiring me to have a primary care physician.  I selected an internist/geriatrician noted to be dedicated to C-STEEEP.  She serves as my health care center of gravity.

   4. And, if/when specialty care is required, my primary care physician and I partner to choose consultants well.

7. Most importantly, my Medicare Advantage Plan is not just an insurance company. It serves as a full partner with my primary care physician and me in my care:

   1. The plan educates me a) about my coverage and b) about the plan’s expectations of me.

   2. The plan rewards, with modest financial incentives, my good behaviors (such as annual visits, immunizations, cancer detection, dietary choices and exercise).

   3. The plan facilitates my access to care:

      1. It ensures I have tools for self-care (thermometer; pulse ox; scale, OTC analgesics; etc.).

      2. My dental, vision and hearing needs are partially supported.

      3. It provides ready access to tele-medicine and urgent care (with modest co-pays) to diagnose, treat and/or outline logical next steps when acute illness intervenes.

      4. It gently discourages (through the pain of significant co-pays) emergency room visits, complex testing (for example, MRIs) and hospital admissions. And…

      5. It offers a prescription drug plan that a) fosters medication compliance; b) avoids polypharmacy; and c) enhances affordability by making an extensive formulary of carefully selected generic alternatives available.

   4. Each month the plan provides me with my scorecard — a readable understanding of my month and my year-to-date medical and pharmacy charges, coverage, and out-of-pocket costs.

   5. The plan provides me with the comforting security of an annual reasonable maximum out-of-pocket ceiling in case I have a (probably inevitable) very bad health care year.

      One of the great advantages of my Medicare Advantage Plan is done with behind-the-scenes smoke and mirrors. On my behalf, the plan has negotiated reasonable prices with clinicians, hospitals, laboratories, and pharmacies.  Actual charges; plan allowed charges; and my responsibilities are clear. Magically, daunting thousands of actual charges become hundreds of approved charges, and my responsibilities become manageable.

8. An important part of my perfect care is my active role. Before each visit with a provider:

   1. I update my personal medical record and present a  legible, accurate, up-to-date copy to my caregiver.  With my meds, allergies and past history at our fingertips, interactions are efficient; and

   2. I write out (word for word) why I am seeking care this day and I present the document to my clinician. Within moments, my caregiver is off and running with clarifications, examinations, testing, diagnosis and treatment.

      My active role is well described in my book (written with Dr. Hightower): Safer Medical Care for You and Yours --- Six Tools for Safe, Effective, Compassionate Care.  I recommend it to you.

      My investment in these preparations generally takes me about an hour. They enable my provider to immediately understand my concerns.  In a New York minute, we are moving in the right direction. For me, my investment is time-well-spent. For my overburdened caregiver, my investment in efficiency and effectiveness is priceless.

9. Most importantly, thanks to our fine American residency and fellowship training programs, when I become acutely ill or require emergent or elective surgery, I may anticipate that caregivers will have the expertise and courage to step up and provide me with that good old care ꟷ compassionate, safe, timely, efficient, effective, equitable (just), patient-centered care (C-STEEEP).

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There you have it — the factors contributing to my perfect health care.  Yet, experiencing perfection, I am overwhelmed with crushing regret?  Many of our fine citizens in our fine decent country are not positioned to receive even basic health care. 

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After review, I observe that basic affordable health care should and must become infrastructure funded by our fine government ꟷ accomplishing that which infrastructure does ꟷ advancing the nation, our communities and the well-being of our individual citizens. 

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As I began today, I alluded to US health care as a chaotic, unaffordable, unsustainable hot mess.  What does that look like?

• The good news ꟷ those of us protected by Medicare and a dollar or two of savings sit in the health care catbird seat.

• But there are the millions of us who live paycheck to paycheck and pay substantial health care premiums for the security of being insured.  All good ꟷ until significant accident or illness intervene and we find that we cannot afford massive deductibles, co-pays, co-insurance and insurmountable annual out of pocket limits.  When we need it most, we are confronted with the cruel reality ꟷ we are only nominally insured (we are woefully underinsured).  When we need it most, we are, in fact, essentially uninsured. 

• Sadly, millions of us do not even have health care insurance.

• What are the consequences of needing health care and being uninsured or underinsured? 

  • Fearing severe economic consequences, we delay diagnosis and treatment.  We suffer along.  (just one of innumerable recent stories: the youngster broke her arm in the play yard.  Crying in pain, she begged the school nurse not to call her parents because “my family doesn’t have health insurance.”

  • Eventually, when we must seek care, fine, talented, expert providers reliably step up and do their best for us.

  • Then the insurmountable bills of unavoidable, emergent care catch up.  For many of us, our basic needs (food, housing, transportation, education and self-worth) become insecure (a statistic ꟷ the majority of health care bankruptcies are pursued bt families who had insurance).

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Cutting to the chase, let me share where these thoughts take me:

1. I declare that our rich, decent and virtuous country must ensure that all within have access to basic daily nutrition and basic health care.

2. If I had a magic wand, I would, as infrastructure, enroll all permanent residents into an efficient Medicare Advantage Plan like mine that is supported by taxes paid into the U.S. Treasury.  Scholars far smarter than I say that such health care for all, for insurmountable economic and political reasons, cannot be achieved. 

3. With this, I must partially agree.

4. However, I am then compelled to advise we are framing the issue wrong.  Although we cannot afford to provide all with my Rolls Royce 5-Star Medicare Advantage Plan, we can afford government supported basic health care (and I want to emphasize the word basic) for all to include:

   1. Taxpayer (US Treasury) funding.

   2. Voluntary participation.

   3. A standardized computer system that creates and maintains accurate and up-to-date personal health care records (I envision artificial intelligence enabling this).

   4. A standardized computer system that records our health care desires and wishes (our health care advanced directives).

   5. A standardized computer system that identifies our health care surrogate decision makers.

   6. Basic health care that ensures (and records) all are immunized.

   7. Basic health care that screens (and records) all for hypertension, hyperlipidemia, breast cancer and colon cancer.

   8. Basic health care that emphasizes wellness education including:

      1. Dietary considerations.

      2. Exercise considerations.

      3. Personal habit (alcohol, drugs, etc.) considerations.

      4. Prevention considerations. And

      5. Guidance on how to prepare to efficiently go to urgent care.

   9. 24/7/365 access to free “call a nurse” advice; And

   10. 8 am to 10 pm access to free urgent care for diagnosis and treatment (prescriptions included) of intercurrent illness. 

5. And then realistically, those requiring care beyond these basic considerations will have to revert to the current system where some (like me) will have access to affordable care and others will continue to face significant clinical and economic challenges. 

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Doug and Kelly, my colleagues Dr. Hightower and Dr. Kellis have been listening in.  Please patch them in so they may conclude this discussion by sharing their personal insights:

Dr. Stephen Hightower from Rio Rancho New Mexico ꟷ please share your observations?

Hello Doug and Kelly.  Hello Dr. Mike.

I strongly believe that the medical profession has worked diligently to try and accommodate many of the American citizens who have not been able to afford

healthcare insurance.  In my career of 42 years these are the experiences I have cared for and seen care for the uninsured:

• In medical school, in our senior year, all students had a 4-week rotation in the walk-in clinic for those without medical insurance. (Talking with other Doctors, this seems to be ubiquitous throughout the US).

• In my Residency in Internal Medicine, I had a specific clinic for taking care of those without insurance supervised by an attending physician, with the goal of monitoring the patient for the entire 3 years.

• In my position as an Internist, I started work with the Public Health Service for 4 years in a small, underserved community in NM. The Hospital had a program for the uninsured every Saturday for 4 hours which each of the four doctors staffed once a month.

• In the Internal Medicine Program in Pennsylvania where I worked for 4 years, I supervised Internal Medicine residents doing free outpatient care for those without Insurance on a weekly basis.

• During a 4-year period working with Baylor Scott and White in a geriatric community setting, I was allowed to place on my schedule any geriatric patient I wished regardless of ability to pay, because I asked to do so.

• In Albuquerque, NM working with Presbyterian Health Care for over 25 years, I had no restrictions on caring for geriatric patients that I deemed in need of care with or without insurance. The system found a way to provide for them

I do not think this is as unique as you might feel.  However, there are many who do not have access to medical care and this has to change. 

I think the potential to provide  BASIC health care as outlined by Dr. White is an excellent beginning for any uninsured individual and could markedly reduce healthcare costs by providing early intervention with minimal subsidies needed to support the program, and with distribution of the program throughout the United States.

Stephen F Hightower MD FACP

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Dr. Dana Kellis from Farmington, Utah ꟷ please share your observations?

Thank you Doug and Kelly.  Thank you Drs. White and Hightower for your insights and cogent suggestions to address the difficult challenges we see in the US Healthcare System.  I want to assure our audience, based on my personal relationship with them over many decades, that these two individuals are some of the best physicians and smartest and finest people anywhere.  Their recommendations come from many years of practice, study, thought, and discussion with other experts, and to me they carry tremendous credibility. 

I recently returned from living in South America for 18 months as a medical advisor to several thousand American citizens who were working there.  While there I had the opportunity to interact with a national health system in depth.  I toured dozens of hospitals and clinics, and spoke with many doctors, nurses, and hospital administrators.  Most importantly, I visited with hundreds of people about their healthcare.  What I saw was appalling.  Many of the hospitals were literally crumbling.  Some had signs on the front door like, “no OB or GYN appointments are available for the next year.”  Americans who landed in a public hospital with a serious illness were panic-stricken, looking for ways to return to the US for treatment.  Despite all of this, the people in the country loved their health care.  Hospitals were run by administrators who worked only 2 or three hours a day.  Doctors who usually had 4 or 5 jobs trying to get by invariably saw patients in the public hospitals.  The care people received was state of the art, if you don’t count ramshackle facilities.  People treated their doctor’s suggestions as inviolate, somewhat akin to the Bible or the law.  For a while, the country had a longer life expectancy than the US. 

The point is that we pay for a lot of things in the US system that don’t improve our health ꟷ skyscraper hospitals, dedicated administrators, hyper-profitable corporations and so forth.  Perhaps what we really need are doctors and patients who trust and care for each other, and whose only goal is for the patient to return to health as efficiently and quickly as possible.  

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Kelly and Doug thank you for this invitation.  Again, if your audience desires to dig deeper, please access www.fixingushealthcare.com/.

www.fixingushealthcare.com/.

Respectfully submitted,

T Michael White MD FACP

Belleair, Florida

fixingushealthcare.com

Copy to: We The People at fixingushealthcare.com