Open Letter to Secretary Alex Azar: How to Survive an Emergency?

Image Source: The Hill

Dear Secretary Alex Azar,

It’s my honor to write to you, United States Secretary of Health and Human Services, whom I trust wholeheartedly because you’ve been entitled by President Trump to be the “star for better healthcare and lower drug prices”. I appreciate your speech last year, during which you laid out a “Value-Based Transformation” of America’s healthcare system, through which “consumers would drive quality and cost-effectiveness with information, competition, and genuine choice”. I admire your vision for a more transparent and accountable system, as well as the ambition to lead a healthcare revolution. Having experienced a medical emergency last year, I would like you to thank you for reassuring us by promising that the current system will not last, as we are on the common ground that “today’s healthcare system is simply not delivering outcomes commensurate with its cost”.

At such a crucial moment of healthcare reform, I urge you to focus on emergency treatment in the US, which I believe is highly problematic and unreasonably costly. Were you surprised at the news that a woman in Boston whose leg got stuck in the gap between the subway train and the platform in Massachusetts Avenue Station begged the passengers “NOT to call ambulance”? This video was widely spread on social media and gained national attention. Don’t you feel worried that Americans are reluctant to receive medical treatment even when their lives are in danger? Undoubtedly, the United States has the most advanced medical technology in the world, but the technology is useless if we are unable to give substantial benefits to our residents. I believe there are noteworthy problems in our emergency medical system which lead to the public concerns on receiving the most fundamental treatment.

Firstly, let’s talk about the cost of emergency service. I did intensive research on the cost of an ambulance ride. However, like the entire US Healthcare system, I found this question to be extremely complicated. As far as I know, the cost of an ambulance dependent on the location, mileage and private/public company, and ambulance service level. According to the U.S. Government Accountability Office, ambulance costs can range from $224 to $2,204 per ride. Larger cities, such as Los Angeles or Houston, usually average over $1000 per ambulance ride. In addition to that, if you have a minute to Google “Ambulance cost in the US”, you will find people complaining about a $3,660 ride for 4 miles, and a $2,700 ride for only 2 miles. It’s troubling that compared to our salary, the cost of an ambulance ride turned out to be unpredictably and unreasonably high. Getting on an ambulance is barely the first step of emergency care. Adding on to the cost of transportation, an emergency room visit typically costs from $150-$3,000 or more. Studies have shown that for cases where critical care is required and/or a procedure or surgery is performed, the cost could reach $20,000 or more. Dear Secretary, the skyrocketing bill of emergency care in the US strongly contradicts to the “cost-effectiveness with information, competition and genuine choice” vision you set earlier this year.

A significant reason behind the expense of emergency care is the for-profit nature of the US medical system. As you know, 21% of community hospitals are for-profit, 18% percent of ambulance service is provided by private companies, and 68% of urgent care centers are owned by corporate entities or individuals. Since private institutions cannot run without making enough profit from each patient, a tradeoff between affordability and profit exists. Advanced medical technology and high-quality service are the privileges of wealthy patients. While it’s acceptable for primary care, because poor patients can endure the minor discomfort of tooth decay, headache, and back pain, I strongly believe that making profits from emergency care is unethical. When patients are in danger of life-threatening disease, permanent disability or even death, we should put their needs first and guarantee the affordability of emergency service.

If we compare the case in the US with other countries around the world, you should be aware that many developed countries, such as Japan, UK, and Sweden never ask patients to pay out of pocket for transportation. In the UK, payment is not part of a visit to the emergency room — for anyone, and there’s no need to show an insurance card or even ID. As an American tourist, “a visit to a UK hospital after an emergency or accident will be free of charge”, which is the same for a trip to see a doctor. Despite being among the top world economic powers, the US remains the sole industrialized nation in the world “without universal health care coverage”. Your proposal last March for a “quality and cost-effectiveness” medical system was a promising start, but it’s now 2019 and America is still restlessly waiting for any substantial measurements to be taken. Please lessen our anxiety by kindly offering a time frame of the medical transformation you’ve promised.

Even for people who can afford the cost of ambulance and ER, it’s likely that they will not be treated on a timely basis. In the US, 95% of patients wait for three hours or less to see a doctor, according to the Centers for Disease Control and Prevention (CDC). This indicates that 5% of unfortunate patients wait for longer than 3 hours to see a doctor. How strong Americans are to endure their severe pain or bleeding cut for 3 hours! You might argue that the high-severity patients take top priority in the ER, so the patients wait for hours and hours are not likely to suffer from acute illness, but are you aware that in the US “only 5.5 percent of emergency visits are non-urgent”? Since a majority of patients are in immediate needs when visiting the ER, all hospitals should strive to lessen the waiting time to the minimum.

When an emergency occurred in my life, the concerns about the medical bill and the waiting time occupied my thoughts. As a student of NYU and a student worker who earns $850 per month, I knew I would have spent most my earnings if I had sought for emergency care because I learned from a friend that she spent $300 when visiting ER for a fever, and she barely received any treatment. Enduring severe pain on my abdomen which lasted continuously for a few hours, I begged my roommate to call an Uber and to send me to Urgent Care instead. Arriving around 9 pm, I was fainting, but the staff at the front desk insisted that I had to complete a form of 3 pages with my signature at 3 places. He checked my ID and payment information attentively, then asked me to find my online insurance card, take a screenshot and send to the email of the hospital before being able to see a doctor. Is this what urgent care is supposed to be like? Since my case was urgent, why couldn’t I see a doctor first before completing the forms? Do my insurance and ID matter more than my life? The urgent care center closed at 10 pm, so both the nurse and the doctor were impatient. The doctor said that it was impossible to give a blood or CT test at this moment. She primarily diagnosed me with appendicitis and gave me a pill of Tylenol what can be purchased in all pharmacies across the country. All my body statistics recorded on the doctor’s note were ridiculously wrong. Their marketing slogans: “Wait Times Are Only Minutes”, “On-Site Lab”, “Advanced Technology X-Ray Machines” is the sheer opposite of the actual experience. Such a visit is a waste of time and money, delaying the crucial time for treatment. To prevent my misfortune from happening on other patients, I propose regulations on urgent care facilities.

Dear Secretary, I don’t assume that all urgent care centers provide terrible services to their patients, but I do ascribe my sufferings to the private ownership of the urgent care center and the lack of regulation in the medical system. The United States never set staffing or equipment criteria for urgent care centers, so that a lot of which are understaffed and underequipped to help patients with crucial conditions. Urgent care centers also inappropriately prescribe antibiotics to their patients and send patients home with very abnormal vital signs. Surprisingly, a study of Yelp review indicates that more consumers rated urgent care centers higher than emergency departments. It’s hard for me to imagine how much people suffer when visiting the emergency departments.

Secretary Azar, I humbly ask you to make the emergency/urgent sector of hospitals not-for-profit through the Value-Based Transformation of America’s Healthcare System. I’m fully aware that transforming any private organization into public is challenging. You might be puzzled over whether spending government budget on such a major project is worthy. You might also be concerned that the private owners and corporate companies, who have more power and money than poor patients, will strongly oppose my recommendation. However, don’t you believe that emergency care is a social responsibility instead of a money-making machine? Don’t you care about patients desperate for expensive treatment? America relies on you to stop any parties from squeezing profits from patients with urgent needs. Only through incorporating emergency care into our social program and subsidizing emergency departments with government budget can we guarantee that affordable and timely services are provided, procedures before treatment are simplified, and mandatory guidelines are implemented.

TEMPORARY 21 — No longer innocent, not yet sophisticated

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