Perfect Health Care Yet, Crushing Regret

By T Michael White MD FACP

“It's better to look ahead and prepare, than to look back and regret.” Jackie Joyner-Kersee

Fixing U.S. Healthcare.Com

Friday, November 1, 2024

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

            I am the rare beneficiary of perfect health care in these fine United States.  My circumstance demonstrates the potential for health care in our country.  Sadly, my outstanding care is the exception.  Seeking an answer for the masses, let us explore my good fortune in detail.   

            My good fortune reflects knowledge, effort, support and a large dose of serendipity.  Let us enumerate the factors that have positioned me for fine care:

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

2. Having chosen my ancestors well, I enjoy fairly good health. 

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

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

5. Upon Medicare eligibility, I did my homework:

   • I chose to reside in a community noted for exceptional medical care;

   • I have selected a regional 5-star Medicare Advantage Plan;

   • Having chosen an option requiring me to have a primary care physician, I have selected an internist/geriatrician dedicated to C-STEEEP to serve as my health care center of gravity; and

   • When specialty care is required, my primary care physician and I partner to choose consultants well.

6. 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:

   • The plan educates me a) about my coverage and b) about the plan’s expectations (what a concept) of me.

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

   • The plan facilitates my access to care:

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

     • My dental, vision and hearing needs are partially supported;

     • It provides access to tele-medicine and urgent care (with modest co-pays) to diagnose, treat and/or outline logical next steps;

     • It gently discourages (significant co-pays) emergency room visits, complex testing (for example, MRIs) and hospital admissions; and

     • 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.

   • 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.

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

7. 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 become hundreds — and my responsibilities become manageable.

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

   • 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

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

   • My investment in these preparations generally takes me about two hours.  For me, my investment is time well spent. For my unburdened 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 elective surgery, I may anticipate that caregivers will have the expertise and courage to step up and provide C-STEEEP.

There you have it — the factors contributing to my perfect health care.  Alternatively, and most importantly, you have a formula (a paradigm) for fixing U.S. health care — 5-Star Medicare Advantage plans for all. 

Perfect health care yet, crushing regret? Few of our fine citizens in these fine United States are positioned to receive even basic health care. After review, I observe that basic affordable health care should/must be infrastructure funded by our fine government. Going forward, I shall advocate for and insist that all have access to basic fordable health care. 

Thank you for giving my perfect care and my regret serious consideration.

Respectfully submitted,

T Michael White MD FACP

Copy: We The People @fixingushealthcare.com 

(With executive/geriatrician Stephen F Hightower MD FACP , Dr. White is the author of

Affordable Basic Health Care for All — An American Health Care System Charter)