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Comment by srikz | Hacker News Reader

I was just thinking about the comparison between the medical industry and airline industry. In medicine you can (or have to) pay a premium to get the best doctors and expertise [1]. In the airline industry, the safety aspect is standardised across the board.

It doesn’t matter if you are flying economy or 1st class you get the best in class safety, which is collectively shared across the industry. We pay a premium for the service and not to have better chances of surviving.

In an alternate universe, we could have had cheaper airline tickets which had not so great safety record and the good ones only in reach of the super wealthy.

[1]: I’m aware it may not be the case in some countries with completely free healthcare, but this applies to the majority of the world. Even in those countries with free healthcare for all, it is not uncommon to see huge wait times for some important procedures and being able to skip it by going through a private hospital.

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There are some interesting experiments with hospital operation models in India that try to make it more like flight. Every patient gets the same surgeon and treatment, but people who pay more get nicer facilities (private rooms, less crowding, separate waiting area for family).

It's not an equal model, but it is more just than what we have in America today.

https://www.bloomberg.com/news/features/2019-03-26/the-world...

Yes, most private hospitals have this model in India where the same surgeons treat the highest paying and the lowest paying patients.

However, the price difference between the base pricing across these hospitals vary a lot and you tend to go looking for that famous surgeon who practices in a hospital where everything is more expensive (Narayana Health and a few others may be an exception).

Also, the other aspect of the airline industry which we should get in hospitals is sharing of best practices. The protocols and procedures which can be effective in saving lives should not be a differentiator, instead it should be standardised and made mandatory.

The differentiators should be non-medical as much as possible.

Of course, only the wealthy hospitals may be able to afford the latest equipments but the expertise of the medical staff and best practices are easily transferrable in a cheap way and shouldn't be guarded like an individual's or the organisation's IP

This meta problem, transferring best practices or as I like to call them "cultural technology" between groups of people, is literally the thing I'm working on right now.

If you're interesting in chatting about this, feel free to email me (in bio) or grab thirty minutes on my calendar: https://calend.ly/labib

That sounds interesting. I'll ping you soon.

That's only true for commercial airlines. Private planes have lower safety records because wealthy clients tell pilots to skip safety checks to save time. And personal general aviators don't have copilot's checking their work.

I think the big difference is that with airlines, it is realistic to have a zero-tolerance approach to deaths, since the default expectation is that a plane will not crash. With hospitals, deaths are innevitable, so you can't just have a uniform set of regulations to ensure no one dies.

Also, I think you can definitely pay more to go on a safer plane - I would imagine more expensive airlines have newer planes and better maintenance - but the risk of death is so small it isn't worth the extra cost.

Things like this make me wonder: is it really worth for the airlines (I'm also talking about plane manufacturers here) to be this secure? I would assume it's not different from the automotive industry, where the security of your product depends primarily on financial reasons.

I feel like many people would be willing to trade some security for better ticket prices.

Of course there are differences with the car industry, one of them being the economic value of the vehicle and thus the loss in case of accident. I don't know if it would actually be profitable for them.

One big difference between the airlines and the automotive industry (or doctors) is that with airlines a crash doesn't just kill the paying passengers. It also usually kills the pilots and other crew.

This sets a floor on airline safety--it has to be safe enough that the airlines can readily find pilots. Some passengers, especially those who rarely travel, might accept more risk for a better price but I suspect that pilots, who might be making hundreds of flights a year, would not be so willing.

Indeed the pilot and flight attendants unions are leaders in driving safety procedures in aviation.

Have you ever heard of a commercial airline advertising its premium maintenance ?

My default expectation is not zero deaths in surgery. Shit happens.

My expectation is that there should be exactly zero surgical instruments that get left inside the bodies of patients, when they are sown up, or zero cases of the wrong organ being removed.

And yet, there's >1,000 cases a year of the former, in the US alone.

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