If Southwest Airlines Was Run Like My Healthcare Provider

If Southwest Airlines Was Run Like My Healthcare Provider

Permission to copy for non profit uses provided credit is given to the author. This was adapted from a humorous discussion item I posted in a graduate medical informatics class at OHSU.

Southwest Airlines is one of the best airlines in the skies and is highly rated by their passengers for superb value and convenience in air travel. Healthcare, on the other hand is viewed by patients as expensive, inefficient, and a poor value. The problems of healthcare are so vast that it is difficult to know where to begin to explain the problems. So I wrote a short story to illustrate from a customer's perspective what Southwest Airlines would be like if the airline operated like my healthcare provider. By placing healthcare absurdities into a different context, the problems are more easily recognized and understood. Again - to emphasize - Southwest is a great airline - this is satire. Southwest does not actually run anything like that which is described below!


Every example given in this story has actually happened at my healthcare provider or insurance carrier.


Assuming that Southwest had the misfortune to operate like my own healthcare provider, you'd have to call a central phone number because, like my healthcare provider, they certainly would not have web-based flight scheduling. Why on earth would customers want to schedule appointments using the web?

Eventually, an operator comes online and says "Southwest Airlines, What do you need?" As you begin to speak, she says, "Will you hold?" and before you can answer, you are placed on hold. A minute later, she comes back and asks, "Is this an emergency?" You say no and you ask for the scheduling desk. After waiting on hold for 5 minutes, the scheduler answers the call.

The scheduler suggests times for your flight that work for Southwest Airlines and their staff. You ask them if they can tell you how much your flight might cost and are told that ‚'it all depends‚' and ‚'its very difficult for us to estimate your actual price'. The scheduler suggests it could range from $57.00 to $357.00, but it is hard to know what it will really cost.

On the day of your flight, you walk up to check in. After waiting in line, the receptionist confirms your appointment for the flight and asks to verify your insurance. If you have no insurance, your flight is billed at twice the rate of those passengers who have insurance. Those patients who have insurance are asked, ‚'Are you sure you really have a need to make this flight? Is there a possibility that you could wait until next week Friday at 10am, or maybe three more weeks before making this flight?"

Everyone is asked, ‚'Did you pack your own bags or were they packed by a terrorist?' And, "How long ago did you pack your bags and why did you not come in when you first packed your bags? You really should have come in right away when you first noticed that your bags were packed!"

Upon paying your co-payment fee, the receptionist hand writes a custom receipt, just for you, opens your ‚'flight records' and makes a handwritten entry in your records. Your flight records are then placed on a holder on the wall, and you are told to wait in the waiting room where you can read magazines that are several months out of date.

Eventually, a staff member gathers your flight records and calls your name and invites you to a private room, where you are mysteriously left alone for a random amount of time before you are finally allowed to board your flight. There are no magazines or windows in this private waiting room and no indication of when you will be allowed to board your flight. A sign on the wall says, "For the courtesy of the pilot, please turn off all celphones and pagers".

A flight attendant comes in to your room, but her pager goes beep and she must leave at once. A bit later she comes back in, and begins to explain the boarding process to you. However, her cell phone rings and she apologizes and leaves the room again. Three minutes later she comes back and says that you may now board the aircraft.

The flight is interrupted because the pilot's pager has received a message about a 'more important' task. This task must take the pilot's attention away from the current flight, and so, the plane is landed at a small airport for a few minutes. While there, the flight crew discovers that the soda cans are missing. They leave the plane to go to a local store to stock up on soda. After returning, the plane taxis out, departs the little airport, and resumes the flight.

When the flight lands, you find it is not at the city where you intended to arrive but is instead about 50 miles away. The pilot had a good idea of where you wanted to go, based on the signs presented by the passengers and believes that his hypothesized destination is a good first stop. The pilot hands you a note, that you can not read, and tells you to take it to the scheduling desk. The note contains instructions that will apparently solve the problem eventually.

The scheduling desk looks at the note and tells you to come back in about 15 minutes. Upon return, the scheduling desk advises you that they do not have a copy of your flight records (the paper records exist only at the origination airport). Because of this, they will need to re-enter some information in to their flight booking system. Curious, you ask why they cannot just transfer the data from the origination airport computer to the destination airport computer? The answer is that our computers at different airports have no way of talking to one another, but "we plan to upgrade our systems" in about 18 months and that will "partially solve" the problem.

Besides, the scheduling desk attendant tells you, the interview will only take about 10 minutes to collect the needed information. The scheduling desk begins to ask for your name, your spouse's name, your children's names, all of their birth dates and social security numbers, your employer and address, your wife's employer and address, your flight insurer's name, group number, address and phone number, the name and phone # of your closest relative and the name and phone number of a local friend to call in case of emergency. Several minutes later, she hands you a pass to take a bus to your final destination.

At your destination, no one is there to thank you for flying Southwest Airlines. Your are pushed out the door to make room for the next customer. One out of every 27 passengers is somehow injured during the flight. Supported by laws set by politicians, many lawyers pile on and file suits on behalf of those who were actually injured, and on behalf of those who thought they might, perhaps, be injured, maybe, in the future.

To re-emphasize, in real life, Southwest Airlines flies Boeing 737 jets exclusively in order to standardize on training and maintenance and achieve efficiencies. Southwest is known for fantastic efficiency and being a great airline on which to fly.

But if Southwest operated like a health care provider, the airline would have numerous jets, none alike. Boeing 717s, 727s, 737s, 747s, 757s, 767s, 777s, DC9 Super 80s, DC10s, L10-11s, MD80s, MD11s, A300s, A320s, a Citation X, three Beech KingAir's and a Tupolov 54. Each pilot would select his type of aircraft, by his or her personal tastes because pilots rank very high within Southwest Airlines. Flight controls will have been customized for each pilot, and in many instances, the pilot will personally select the crew. Sometimes pilots do not get to have their very own aircraft, so the maintenance crew carefully repaints each aircraft and stocks just the items on the plane that the pilot desires.

Four months after your flight, you receive in the mail a statement for services that says, ‚'This is not a bill', and it reads:
11/01/01 SWA 838 8Y 1187493 $197.00 PPO Adjustment $-20.00 Less Customer $-20.00.
11/01/01 SWA 838 1Z 1189827 $25.00 PPO Adjustment $0.00 Less Customer $0.00
11/01/01 SWA 838 A3 1892345 $10.00 PPO Adjustment $0.00 Less Customer $0.00
11/01/01 SWA 838 F1 1809348 Misc supl. $75.00 PPO Adjustment $0.00 Less Customer $0.00
11/01/01 SWA 838 ZZ 9999999 Records $30 PPO Adjustment $0.00 Less Customer $0.00
A few weeks later, your ‚'flight insurer' mails you a statement that bears some similarity to the above, with the notation, ‚'flyer responsibility Code 7890' and ‚'You owe $222'

After calling your flight insurer, you learn that your annual flight deductible has not yet been reached, so you must pay the full amount. Unfortunately, you really do not remember what this flight was for and there is no human readable information on the bill. You remember taking a flight somewhere around then but do not remember what all those funny charges are about.

When you call the airline to ask, you are placed on hold for 5 minutes, and then transferred and placed on hold for 15 minutes. Finally, you speak to a person who places you on hold while fetching your flight records, which are handwritten on a ‚'Flight chart' record. After reviewing your flight chart, the person advises that you were charged $25 for a paper ticket to fly on the airline, and $10 because we needed to have a soft drink available whether you drank it or not. The $75 was for your portion of the fuel that was used during the flight and the $30 Records charge was because we had to collect all of your billing information again at the destination airport where we mistakenly left you.

You argue that they never used to have all these charges on their bill, but the person insists that ‚'You were supposed to have been surcharged in the past' and offers to mail you a copy of the bill you already have in your hands. She also notes that the airline should have charged you a separate ‚'$10.00 infectious disease control cabin air' fee. Furthermore, according to their records, we believe you may not have paid your co-payment on a previous flight and you still owe us an additional $20.00. You argue that you still have the hand written receipt from that flight that shows you made that co-payment. "Well, since our records do not show that hand written receipt, you will need to photocopy the receipt and mail it to the accounting department. In about three months, we should be able to remove that charge from your bill."

Reluctantly, you pay the bill.

Shortly after this episode, Southwest Airlines announces it is raising its rates by 23% in the coming year, on top of the 15% increase during the current year. Southwest insists that this increase is due to escalating costs of operating its business and complains loudly that the flight insurers are not adequately reimbursing them for their actual costs.

Flight insurers increase their monthly premiums by 28%, citing the rapidly increasing costs of health care (and ignoring their own investment losses).

Small business owners say they are going to be cutting out flight insurance for their workers.

Flight customers demand greater access to affordable health care, where they define "affordable" as being paid for by someone else.

The Pilot's Aviation Association goes on record supporting "universal flight access" as a basic right, if paid for by someone else.

Politicians proclaim that we must to do something about these rising costs. Their proposed solutions include:
1) Specifying seven additional beverages that must be carried on every flight,
2) Creating a taxpayer funded flight insurance program for children who's parents are not covered by their employer
3) Identifying three new destinations that insurers must pay for, in full.
4) Requiring that all airlines provide coverage for extra over sized baggage.
5) Proposes to address the high prices for flights by spreading the costs to a larger group of people.