Commentary: Should Medicare be run like the airline industry?

The Kansas City StarOctober 22, 2012 

One of the best laugh lines in any Republican’s stump speech is a claim that Obamacare brings the “efficiency of the Post Office and the charm of the IRS” to the nation’s health care system.

The line, first attributed in a different context to Ronald Reagan, brings chuckles in part because the Affordable Care Act is a tangle of rules, regulations and government oversight.

But maybe Reagan’s knee-slapper works in the other direction, too. Maybe privatizing some government functions — like, say, Medicare — would bring unintended results.

Republicans have talked this year about offering a private insurance alternative to Medicare as a way to reduce costs while maintaining quality. Free-market incentives, they argue, can accomplish both goals.

Let’s see how that might work in practice.

In 1978, Congress passed a bill deregulating the commercial airline industry. The law abolished what was called the Civil Aeronautics Board, a government agency that set fares, established routes, regulated customer service standards — essentially, the CAB ran public air transportation for decades.

By one measure, getting rid of the CAB has been an unqualified success. Air fares, adjusted for inflation, have dropped dramatically, in some cases by more than 75 percent. Airline travel, once a luxury for the wealthy and for business people, is now affordable for almost everyone.

And commercial flying is as safe now as it’s ever been. In part that’s because the safety functions of the CAB were transferred to federal agencies, which have done a good job of keeping an eye on safety practices.

So flying costs are indeed lower, reinforcing GOP claims about possible savings from a private Medicare.

But what about quality?

Largely free of government oversight, airlines now cancel flights on a whim, cram passengers into overcrowded aircraft and charge fliers for their luggage. In-flight food service means a bag of pretzels and ginger ale, for a price. You check yourself in. Lost bags, late arrivals and underserved regional airports are commonplace.

Not to mention the bankruptcy of legacy airlines such as Eastern, Braniff and TWA, and the jobs lost when those companies went under, as well as reduced pension benefits and health coverage for retirees.

Private screeners run security at KCI, but lines are just as long there as at other airports. And a planned reconfiguration of KCI is about lowering costs for airlines, not your convenience.

So decades after airline deregulation, it’s unquestionably cheaper to fly, but it’s also much more difficult.

Put another way: Should Medicare be run with the efficiency and charm of the airline industry? Those pondering that question may wish to book a flight first.

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