A Hard Lesson For Health Care Reformers From Horrific D.C. Plane Crash

For everyone who believes the brokenness of U.S. health care demands immediate attention, consider this: Despite grim warnings about hazardous air traffic control understaffing, preliminary evidence indicates the horrific D.C. plane crash happened because this life-threatening problem was not addressed even in the airspace used regularly by virtually every member of Congress.

No health care reform problem remotely approaches that level of personal concern to policymakers. Small wonder, then, that Congressional responses to far more abstract issues like, say, the primary care physician shortage, bog down in immovable policy inertia.

While the cause of the collision between an American Airlines commuter jet and an Army Blackhawk helicopter remains under investigation, the Washington Post disclosed a government report that two controllers were trying to do a job that required four people, including separate individuals tasked to monitor helicopter and winged-aircraft traffic.

The danger of air controller understaffing was meticulously laid out over a year ago in a page one investigation by the New York Times, which carefully documented how understaffed air traffic controllers were being “pushed to the brink” and “increasingly prone to making major mistakes.”

Health care reformers frustrated over the policy response to physician burnout should step back for a moment. An American Medical Association report on the topic describes symptoms like “emotional exhaustion” and “work frustrations.” In that report, 48% of physicians reported experienced “at least one symptom of burnout.”

Now look at the Times investigation of air traffic controller burnout, in a job that is the epitome of constant stress. The newspaper found a “fatigued, distracted and demoralized workforce” often forced “to work six-day weeks and 10-hour days.” In the year ended Sept. 30, 2023, “significant” air traffic control lapses jumped 65 percent from the previous year, with some controllers telling the newspaper that “they fear that a deadly crash is inevitable.”

Yet even those alarming facts led only to the formation of a special investigative committee by the Federal Aviation Administration.

Or take medical debt, another target of health care reform concern. A widely cited KFF analysis of Census Bureau data found that 41% of U.S. adults had medical debt in 2021. But only 6% had debt over $1,000, and even that definition included not only unpaid balances on credit cards but money owned to family members. Moreover, with total debt by U.S. consumers being “at an all-time high,” according to data cited by Motley Fool Money, medical debt looks a lot less like an isolated problem related to health care prices and more like a broader economic issue. For instance, credit card and loan delinquency rates were “at levels not seen since the 2008 recession.”

Finally, of course, there’s medical error. A 2023 report by the President’s Council of Advisors on Science and Technology declared, “Patient safety is an urgent national public health issue” and cited a government study showing that “approximately one in four Medicare patients experience adverse events during their hospitalizations, with many resulting in catastrophic outcomes.”

Patient safety may be urgent from a moral point of view, but how it’s treated in day-to-day care is reflected in a national survey of patient safety culture. About half of hospital respondents said that management seemed interested in safety “only after an adverse event happens.” Underreporting of error, which the PCAST said is rampant, makes those “adverse events” even less likely to affect policymaker priorities, despite organizations like the Leapfrog Group concluding that more than 160,000 lives are lost each year to preventable medical error.

The collision of the American Airlines commuter jet and the Army Blackhawk helicopter that took 67 lives was captured in a horrifying instant by an airport camera. Preventable medical error takes roughly the same number of lives every four hours every single day of the year.

Nonetheless, for those committed to addressing patient safety, medical debt, physician burnout and a long list of other “urgent” health policy issues,” the air collision tragedy offers a hard lesson. Waking up the U.S. Congress to take action, even when it involves dire preventable hazards that could affect them directly, too often requires the equivalent of a sickening bright flash in the nighttime sky.