ANALYSIS: Health care quality would improve for all if we had a federal watchdog

— -- This is the third article in a five-part series.

In my last article, I talked about costs out of control in American health care. In this one I will talk about quality.

First, think about a life-and-death industry you know that is under tight federal government control in many ways, to the unquestioned benefit of all Americans who use it. If you chose aviation, you are correct.

Think about the incredible safety record of the commercial airline industry; I’ll bet you can’t even remember the last crash in this country resulting in a large number of fatalities. The National Transportation Safety Board says the last major accident in the U.S., with 45 fatalities, was in 2009. The airline industry is continually improving its safety records, according to the Aviation Safety Network, with an average of only one fatal accident per 3.2 million flights worldwide.

Now contrast that with an estimate from the impartial research organization the Institute of Medicine, or IOM, which said that 98,000 Americans die from medical errors every year.

Why this stunning difference? One reason is the strong federal role in airline safety. When you get on a commercial airline anywhere in this country, aren’t you glad it is the federal government that sets the standards for how and when planes and pilots are examined and certified — and that we don’t leave these life-and-death decisions up to each state? This is one of the many reasons that I think returning major health care policy decisions to the states is a terrible idea.

Read articles in this series:

Part 1: ANALYSIS: 3 health care problems could shape the next decade
Part 2: ANALYSIS: Health care spending reforms are critical to change the system
Part 4: ANALYSIS: Health care should be a right, but the US doesn't have a system
Part 5: ANALYSIS: The 2 options for US health care likely to emerge in the next decade

This lack of similar federal supervision greatly contributes to the very uneven quality in American health care. There are many clinics and hospitals in this country that offer the very best care in the world. Others are dangerous and substandard —- and everything in between.

One of the reasons health care can be so variable is that we Americans strongly believe in the free market to control pricing and quality. For traditional commodities —- cars, refrigerators, homes, etc. —- that belief is well founded. That’s because in a free market for traditional commodities, the consumer is king. We consumers can become informed, shop in the store or on the internet and decide if we like the product and price. If we don’t, we can walk away.

But there is usually no such leverage for the average consumer in health care. It is very hard for people to become fully informed about price and quality while in the midst of illness or anxiety about symptoms. We don’t usually dicker about price, and it is very difficult to walk out the door, especially in true emergency situations.

Unlike the marketplace for commodities, the health care marketplace is not subject to the usual forces of supply and demand. In the case of health care, both supply and demand are on an intense upward trajectory, driven by the insatiable demand we Americans create for the newest and latest options —- and the medical industry’s constant output answering that demand with new and costly devices/tests/drugs/treatments.

Indeed, the health care industry spends hundreds of millions every year on lobbying and campaign contributions to Congress to protect its interests. According to the Center for Responsive Politics, health care and health insurance industries have spent more than 4.7 billion on lobbying since 1998.

So, I am one of those who has lost faith in the political process to ensure that our safety and health care costs come first. But before I offer my thoughts on how to solve the problems of cost and quality, I must address the problem of affordable access. That’s the subject of my next essay.

This is the third in a five-part series. Read other articles in the series below:

Part 1: ANALYSIS: 3 health care problems could shape the next decade
Part 2: ANALYSIS: Health care spending reforms are critical to change the system
Part 4: ANALYSIS: Health care should be a right, but the US doesn't have a system
Part 5: ANALYSIS: The 2 options for US health care likely to emerge in the next decade

Dr. Tim Johnson was the chief medical editor for ABC News from 1984 to 2009.