If air travel worked like health care

By the excellent Jonathan Rauch, this unexcerptable piece is very funny (and sad).  

I wonder what it would be like to extend this series: if Whole Foods worked like health care, if the internet worked like health care, if higher education worked like health care…wait…higher education does work a bit like health care.


What if waiters worked like academia?

See pp. 134ff here:


Air travel is awful. Try again.

..and one in ten planes would crash and kill you.

One thing they have very much in common, the body cavity searches. Bada bing!

The hospital is one of the few places where I get the impression that there is too much division of labor. So much cash is being thrown off and so many experts resisting leg work that they can hire people just to see if they will find something to do. And also the class system sticks out. Academia is a class system. But, since it is so unprofitable, the grad students don't get much help, so the division of labor isn't excessive. An experienced grad student will know almost everything because they have to do everything. And academia could not run without the class system.

Air travel is screwed up without a doubt. But it is still better then health care.

This is not obvious if you have insurance.

I have good insurance and health care works about as well as air travel for me.

But my brother has no health insurance.

The problem is not that he has to spend money out of pocket to buy health care. The problem is that simple economic transactions that we take for granted are almost impossible to undertake when buying health care with out of pocket cash.

I bet a small plane repair shop works like healthcare.

"The problem is that simple economic transactions that we take for granted are almost impossible to undertake when buying health care with out of pocket cash"

Well...let's fix THAT problem.

"odds are it won't be the same price you paid"

I have this same discussion at work from time to time, and I contend there is nothing unusual about it. Ask someone else what they last paid for gasoline, milk, or bread. Odds are that it won't be the same as you paid even though a gallon of gas or whole milk or a pound of bread have roughly the same content. Prices change; contrary to the O'Reilly Gas Price Theory, there is no "one true price" with all deviations falling into the categories of either gouging or predatory pricing. (Of course, if they were all the same and never changed, there would be widespread accusations of collusion).

It occurs to me that maybe this air travel/health care analogy gives some insight into dealing with the issue of medical malpractice, too. When a plane crashes, for example, the National Transportation Safety Board is instantly all over the scene. They figure out what went wrong and who's at fault, and make recommendations on how to improve things so the problem doesn't happen again.

Now, imagine what airline safety would be like if the current medical malpractice system was applied to airlines. Scary, huh? And now try imagining it the other way: what would the health-care system be like if adverse medical incidents were investigated, and conclusions promulgated, with as much rigor as NTSB applies to airplane accidents? I kinda like the picture that emerges...

Now, imagine what airline safety would be like if the current medical malpractice system was applied to airlines.

It is the same system. What are you talking about? I think one of the "malpractice lawsuit" cases in the 911 has just gone to trial recently. While the Congress passed a blanket bailout of all the insurers and parties to quickly settle the expected five to ten thousand lawsuits, a few people didn't agree to the settlement even though taking taxpayer money was the solution. One father wants to get a legal record of what went wrong to allow the airplane that killed his daughter to be hijacked, wants to know who screwed up. And that is the story for a lot of malpractice lawsuits, if not for the compensation.

Perhaps you are arguing that the government should handle the mass casualties of the health system like Congress handled them for 911: give a big pool of money to a special master who sets rules and passes out lots of money to the victims?

I believe that the government paid big settlements to avoid the malpractice lawsuits on the shuttle disasters.

Every plane accident has lawyers rushing into find clients to file their malpractice lawsuits. And with all the data legally required to be provided to the government which puts it into the public record, the incentive is to settle the lawsuits.

The link is not working.

Healthcare for the uninsurables and elderly is nothing like air travel. For the relatively young and healthy it could be. But not with more complex cases like the above.

With complex cases like many of those in Medicare, how do you price and plan a trip where the final destination might change as the person travels? In fact the route may change as the trip proceeds. Some may have more or multiple different stops along the way. The buyer/traveler/patient might have a few clues about this, the travel agent/doctor might have a few more clues and knowledge about the route, and the insurer/airline might know more or have different guesses about the route and cost. How do you post a price without knowing the specific route and trip?

If you have a job like 60% of the families, it is employer paid hunger satisfaction; every payday you get money for food

Nope, wrong. Every payday you get money, period. You can use it for food, or you can use it for something else. Naturally, you will use some of it for food, housing, and other necessities, but since you can spend the surplus on other things, you have an incentive to be choosy about how much you pay for those necessities. Because people are price sensitive, grocery stores have transparent pricing so that people can comparison shop. Stores also compete on quality so that they can (they hope) charge a bit more. In other words, it is exactly the opposite, in every important respect, to the way we buy health care.

Pete, such a good point. That's why I always take an ambulance when I get my eyes checked, take a flu shot, go for my annual check up, collect my topical cream, ask my doctor about a new prescription drug, or have my teeth cleaned.

. Your post is helpful in this case. it will help people know about such nobel events and will create awareness.

I'm afraid that this system may work only in highly developed country.

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