While the cause of the horrific collision between an American Airlines commuter jet and an Army Blackhawk helicopter remains under investigation, the Washington Post disclosed a government report that two air traffic controllers were trying to do a job that required four people, including separate individuals tasked to monitor helicopter and winged-aircraft traffic.
The failure by Congress to respond to the danger of air controller understaffing, despite a page one investigation by the New York Times laying out in 2023 how air traffic controllers were being “pushed to the brink,” could not help but remind me of the inaction that’s so frustrating in health care.
There’s the health care burnout problem, less acute, but no less connected to life-and-death than that of air traffic controllers. An American Medical Association report on the topic describes symptoms like “emotional exhaustion” and severe “work frustrations.” In that report, 48% of physicians reported experienced “at least one symptom of burnout.”
There’s medical debt. A widely cited KFF analysis of Census Bureau data found that an astounding 41% of U.S. adults had medical debt in 2021. What likely makes the burden heavier is that total debt by U.S. consumers is “at an all-time high,” according to data cited by Motley Fool Money. 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.”
The Biden administration responded to that report on World Patient Safety Day in 2024 by unleashing what one publication called a “blitz” of new programs and other actions aimed at making care safer. There was even a panel hosted by Patients for Patient Safety (US), which I co-moderated, that featured leaders from the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Office of the Inspector General of the Department of Health and Human Services and the Veterans Health Administration.
Thanks to the Trump administration’s draconian orders restricting even innocuous health data releases and putting virtual handcuffs on actions by career government employees, those modest steps towards protecting Americans of every age, gender and political persuasion from preventable harm seem like a long-ago dream. I wrote then for Forbes of “a possible turning point in the power of the patient voice in policy.” For now, unfortunately, that turn seems to have run into a dead end.
When the modern patient safety movement first came to life in the 1990s, Harvard’s Dr. Lucien Leape would regularly compare the death toll to the equivalent of a crash by a 747. The point was that we would never tolerate a level of unsafe aviation the way we tolerate unsafe patient care. Despite what the advisory council report said is widespread underreporting of error, there are still more than 160,000 lives lost each year to preventable medical mistakes, according to the Leapfrog Group.
The collision of the American Airlines commuter jet and the Army Blackhawk helicopter that took 67 lives was horrifying. So, too, is the loss of life from dangerous medical errors, crippling medical debt and the deterioration of working conditions for physicians. And so, whether in aviation or health care, we keep striving for change.
“He who saved one life,” says the Talmud, “is as if he saved the entire world.”
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