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www.TheHealthCarePapers.comCopyright ProtectedBelleair, Florida 2020Rio Rancho, New Mexico 2020The HealthCare PapersResearch in Search of an American Health Care SystemEdited ByStephen F Hightower MD FACPT Michael White MD FACPNEW!!#24 Medical Stability for the Populace — A Key to a Decent LifeStephen F Hightower MD and T Michael White MD“I am terribly glad to be alive and when I have wit enough to think about it, terribly proud to bea man and an American with all the rights and privileges that those words connote.And most of all I am humbled before the responsibilities that are also mine. For no right comeswithout a responsibility and being born luckier than most of the world's millions,I am also born more obligated.”Wallace StegnerSunday, July 26, 2020Editors The HealthCare Papers,Emile A. Nakhleh is a research professor, director of the Global Security Policy Institute,and former senior intelligence officer at the CIA. In a recent article written in March of 2020, hesuggested that, with regard to the steps the United States needed to take to stabilize WestAfrica, “the Trump administration should increase the State Department’s budget forcommunity engagement in West Africa with programs that would cover health, education,Page 1 of 120

www.TheHealthCarePapers.comwomen’s health, clean water, farming, job creation as most people in the region are moreinterested in providing a decent life for their families, educating their children, and putting foodon the table.”Is this any different for the 37million United States citizens who are unable to affordhealth care or the 40 million who are underinsured? Health care is a necessity to maintain theintegrity of families for people around the world. The United States is currently battling aprogressive virus that is now at the forefront of all Americans’ minds, but we have almost 80million citizens who are under-prepared to deal with this adversity and whose only hope at thismoment is left to chance. Will they be able to afford medical treatment or a prophylacticvaccine if either were to be developed?In 2010 Medicaid expanded to include individuals up to 138% of the poverty level, or anannual income of 35,535. Data from 2019 by the Kaiser Family Foundation from states thatprovided that option noted the following: increased access to coverage; increased financialsecurity; improvement in health outcomes; and economic benefits for states and providers whoparticipated in the care of these patients.Recently, multiple other states have begun to request inclusion in the program which ispaid for by the federal government at 100% for several years. After that period states pick upsome costs, with a maximum cost to them of 10%. This type of program is what Mr. Nakhlehidentified as a necessity for a third- world country, yet we cannot even convince all of our statesto agree that their own citizens are worth this additional 10% cost.Infectious disease can be controlled and slowed when the affected population acts onthe recommendations made by experts. Only health care for all will make our country safer astreatments and prophylaxis become available. The recent focal measles epidemics, resultingfrom contact with unvaccinated children, reminds us to not underestimate the virus or thevalue of the vaccine. If we can generate billions of dollars to help our neighbors around theworld, we should do so; and we should use equal resources to help our own citizens. I have nodoubt that our communities would appreciate having access to programs covering health,education, women’s health, clean water, and job creation, since most of us, like our worldneighbors, are just interested in providing a decent life for our families, educating our childrenand putting food on the table.485 wordsRespectfully submitted,Stephen F Hightower MD FACPGeriatric and Internal MedicineRio Rancho, New Mexicothcpsfhmd@gmail.com(Dr. Hightower edits The HealthCare Papers)An addendum Dr. Hightower’s #24 Medical Stability for the Populace — A Key to aDecent Life represents the 24th bite at The HealthCare Papers — Research In Search of anPage 2 of 120

www.TheHealthCarePapers.comAmerican Health Care Plan apple. His clear, concise exposition has me remembering, the poets’Paul Stookey, James Mason and Dave Dixon and their lyric (I Dig Rock and Roll Music), “I think Icould say somethin’ if you know what I mean.” Dr. Hightower has said it.The good citizens and permanent guests in these fine United States are entitled to thedesign, maintenance, implementation, funding and continuous improvement of health careinfrastructure. Although life’s twists and turns (and pandemics) may jostle the highly skilledassembly line worker’s employment (and that of millions like him), his family’s fresh air, publicsecurity, local transportation, clean water and health care must not be placed in jeopardy.Robust infrastructure must be there to allow him (and the millions of others like him) to shakeoff the blow; get his pins securely back under him; and put his hearth, home and life, and thelives of those near and dear to him, back in order. Given just a whiff of a chance, we know hewill.For clarification, concern, although influenced by pandemic, predates this pestilence.Please take a moment to give #1 Our “Insured” Near and Dear Are Uninsured another turn. Inhealthy 2019, despite paying massive healthcare insurance premiums, unless protected by vastwealth our highly educated, fully employed, hard-working near and dear (and the millions lessfortunate than them) were (and remain) uninsured. Intercepted by serious accident or illness,fates will dissipate their hearths, homes, educations, security and their hard-earned, welldeserved treasured dignities.We are all privileged to live in these fine United States. Generations ago JFK observed,“Privilege is here, and with privilege goes responsibility” — responsibility to design, implement,maintain and continuously improve infrastructure for this fine country’s current and futuredenizens. Time is wasting. Let’s go.325 wordsRespectfully submitted,T Michael White MD FACPA HealthCare Value ProfessionalBelleair, Floridathcptmwmd@gmail.com(Dr. White edits The HealthCare Papers)Table of ContentsI.II.Prologue — The HealthCare PapersAbout the Editors6Page 3 of 120

www.TheHealthCarePapers.comIII.IV.Submissions — Encouragement and FormatRelevant (Proudly Purloined) LinksV.Opinion Editorials and Comments#1Our “Insured” Near and Dear Are UninsuredStephen F Hightower MD and T Michael White MDOur Health Care System Is BrokenT Michael White MDHealth Insurance — The View from the TrenchesKalim Ahmed MDMedicare — Not Free — Is a Worthy Investment (Worth Sharing)Stephen F Hightower MD and T Michael White MDLogical, Functional, Affordable — COVID-19 Compatible — HealthCareStephen F Hightower MD and T Michael White MDSingle Payer Health Care — A BlessingJay Stearns MD and Stephen F Hightower MDBulletin — You Are Now the DoctorStephen Hightower MD and T Michael White MDUnderstandable and Explainable End-of-Life Desires and WishesStephen Hightower MD and T Michael White MDWhen I’m 84 Part 1 — The Challenge of Progressive Disease in theElderlyStephen Hightower MD and T Michael White MDWhen I’m 84 Part 2 — The Cost of Health Care for the ElderlyStephen Hightower MD and T Michael White MDTwo Health Care System Quick Fixes — The Consumer and Medical LiabilityMr. Charley David Price and T Michael White MDMy Hope for the Future of Health CareMs. Maureen Theriault MA BA and Stephen F Hightower MDTriskaidekaphobia — Moving OnWhen I’m 84 Part 3 — The Debate About the Rationing of Health CareStephen F Hightower MD and T Michael White MDNone Are Protected Unless All Are ProtectedDana S Kellis MD PhD and Stephen F Hightower MDDiagnosis and Data Collection System (DDCS)A Human Body Nano-Analyzer and Database#2#3#4#5#6#7#8#9#10#11#12#13#14#15#16Page 4 of 120

4Mr. James R Audet and Stephen F Hightower MDBurnout — A Primary Care PerspectiveDr. Anonymous and Stephen F Hightower MDAn Open Letter to Self — Keep and Stay SafeT Michael White MDConsidering Health Care RationingJay Stearns MD and Stephen F Hightower MDPrimary Care of the Future — Free Care Lowers CostsDavid E Lippman MD and Stephen F Hightower MDAdvancement of an American Health Care System — Amend the Affordable Care ActAttorney Michael Keehan and Dr. Stephen HightowerSuccessfully Addressing Social Determinants and Barriers to HealthStephen F Hightower MD, Jeannine Hightower BA and T Michael White MDUniversal Traditional Health Care? — A Qualified YesT Michael White MD and Stephen F Hightower MDMedical Stability for the Populace — A Key to a Decent Life96Stephen F Hightower MD and T Michael White MDVI.Long Reads: Essays and Fictions#1EFMedicide — A Failure to Make Whitefish BayW Ryder BlackCoronavirus — Our Health Care System ExposedDavid Emory Lippman MD2-Club Pandemic Golf — Avoiding the Rule of Unintended ConsequencesW Ryder BlackPandemic GolfAnonymous#2EF#3EF#4EFVII.Epilogue (a work in progress)120Page 5 of 120

www.TheHealthCarePapers.comI.Prologue — The HealthCare PapersThe question must be asked — what is this The HealthCare Papers — Research In Searchof an American Health Care System? There is an answer (a raison d’être) to this fair query.Health care is a critical segment of our country’s infrastructure. Like airlines, railroads,highways, bridges, waterworks and power grids, health care is glue that enables society tofunction. But, to date, health care’s role in infrastructure is neither recognized norsystematically addressed.The Bing dictionary defines a system as “a set of things working together as parts of amechanism or an interconnecting network.” Familiar to many, Southwest Airlines, serves as anexample of a system. Our nation’s health care does not conform to the definition. Whilemiraculous care is provided daily, the circumstances are anecdotal not systematic.Despite infinite potential, devastating physical and financial consequences of the failureto provide predictable access to basic affordable health care occur daily. Worse yet, leadershipparalysis afflicts movement towards the design, implementation, maintenance and continuousimprovement of solutions.Drama aside, telling it plain, America’s health care is in crisis. Importantly, although thisobservation is amplified by the COVID-19 pandemic, it predates the pandemic and crisis will notbe alleviated if/when the pandemic is resolved.As physicians, we (Editors Hightower and White) recognize continued silence on ourpart equates to enabling complicity. Having solemnly sworn to careers advancing safe, timelyeffective, efficient, equitable (just), compassionate patient-centered care, we cannot abidesilence. Privileged by experience in the trenches, we are obligated, with humility, to share ourclinical and leadership perspectives and insist upon a health care system that cares foreveryone.The question — how may we best communicate concerns, communicate solutions andimpact change? After a pilot involving dozens of thoughtful minds — administrators, cliniciansand patients — we have come to understand:1.We must take action;2.Our tone must be professionally compassionate and kind;3.Our strategy is to edit and publish this book, The HealthCare Papers — Research InSearch of an American Health Care System, bit by bit on the web in real-time;4.Our vehicle will be the webpage www.thehealthcarepapers;5.Delivery will be through an email list (please ask to be included; please forward tointerested parties);6.Submissions (opinion editorials, essays or fictions) will come from interested parties(please submit);7.Thoughtful responses to a specific submission will be annexed to that submission(please respond); andPage 6 of 120