First, this question: Can you name an industry that is heavily regulated by the federal government — versus state governments — to the obvious benefit of all Americans who use it? If you picked the airline industry, you are correct.
Think about it this way: When you get on a commercial airliner anywhere is this country, aren’t you glad it is the federal government that regulates how and when planes have to be inspected and pilots recertified? Put another way, as you sit on a runway in Boston or Biloxi or any other American city, aren’t you reassured that we don’t leave life and death decisions about airline safety and effectiveness up to each state?
Put still another way, it is no accident that the commercial airlines in this country have an astounding safety and effectiveness record — unlike the medical industry, which has a very uneven record, in large part because we do not have similar federal regulation of this critical enterprise. The impartial Institute of Medicine once estimated there are 98,000 deaths each year in the U.S. from medical errors. Obviously, if that occurred in the airline industry, it would be shut down immediately. But deaths from medical errors usually occur one by one behind closed doors or pulled curtains, often not even recognized as the result of error.
So why not insist on something similar to the airline industry for health care? Why not require that all health insurance policies meet certain basic federal requirements so that no matter what plan you choose you can be assured that they meet guaranteed national standards for safety and services?
Allowing states to make these decisions without required federal standards would be like allowing airlines to set up shop in the state with the least demanding safety and service standards; the ticket price may be lower, but the gaps in service and safety could be lethal. I would argue that buying health insurance should be done with the same assurance of safety and effectiveness as is the case in buying an airline ticket, given that both involve services and devices that are far too complicated for the average consumer to understand.
In that sense, the free market does not work for health care insurance as it does for cars, refrigerators and even homes — all commodities that can be understood using information readily available to the average consumer. In contrast, trying to evaluate the quality and safety of complicated health insurance policies is virtually impossible.
And doctors and hospitals are intensely competitive for Medicare dollars — witness the heavy advertising aimed at senior citizens. In the case of Medicare, the government also negotiates payments with providers — which is why Medicare patients get a much better deal for the same services than those with individual private insurance. In fact, whenever I speak to audiences about health care, I ask all the Medicare patients in the audience to put up their hands. Then I ask people to drop their hands if they want to give up Medicare and go back into the private health insurance marketplace. I have yet to see a single hand go down.
We are not yet politically ready in this country for Medicare for all, but we should be ready for some kind of federal government guarantee of safety and basic care for all. If we wouldn’t dream of leaving air travel regulations up to individual states, why should we do so for health care?
Dr. Timothy Johnson is an ABC News senior medical contributor. He was the chief medical editor for ABC News for 25 years.
Any opinions expressed in this column are solely those of the author.