Unintended Consequences

Although I’m not a hard core movie fan, my wife and I did see “The King’s Speech” a week before it won Best Picture at the Oscars.  Another favorite flick that never won an Academy Award nomination was the 2004 “50 First Dates,” in which Lucy (Drew Barrymore) suffers from “anterograde amnesia” as a result of a car accident she was in a year earlier. The condition has left her unable to convert short-term memories into long-term memories, so she literally can’t remember from one day to the next.

 Enter marine veterinarian Henry Roth (Adam Sandler), who meets her in a café, they hit it off, run into each other again the next day, but she doesn’t remember him from the day before, leaving Henry perplexed and dejected. The guy who runs the café clues Henry in on what’s going on, and Henry capitalizes on the chance to make a new first impression with Lucy every day. 

There are plenty of times when I could have benefited from a second chance at the first impression.  This premiere installment of Medical Sense probably isn’t one of those times, so this is my shot to make a good first and only first impression.  Let me know what you think.

There are many debates going on in politics right now, and depending upon the day of the week in the news cycle, government run health care is front and center as we hit the first anniversary of the signing of the legislation by the President.  As with just about any public policy debate, a topic that doesn’t always get much attention is that of the “unintended consequences” of the legislation. 

The federal government generally isn’t very successful at running anything it “subsidizes,” or outright “takes over.”   Delivering the mail and maintaining a national railroad are two examples that can’t seem to operate without regular infusions of taxpayer cash. Managing mortgage loans and building cars are more current examples, but all things aviation, however, are inherently governmental functions.  Aircraft certification, air traffic control, and pilot medical certification generally receive passing marks from most of the user community, despite their governmental oversight. 

The adverse unintended consequences of federalizing and mandating single-payer universal health care for everyone (except the special interest groups who are being granted “waivers” by the thousands) concerns me a lot.  In the evolving landscape of “ObamaCare,” one scenario of government proscribing “who gets what treatment and when” has potentially serious implications for pilots who are under tighter FAA oversight of their medical certification.

Special Issuance Authorizations are issued for lots of different medical conditions, and those authorizations are contingent on the FAA getting something from the pilot on a regular basis, usually every year.  Balancing the mandates of federal regulatory medicine against the accepted “Standard of Care” that our current health care system employs seems to be working fairly well.  Despite the protestations of some airmen about the FAA’s requests for “unnecessary” testing to determine one’s eligibility for medical certification, the FAA is, by most accounts, balanced and reasonable in what they ask for and how often they ask for it.

 A common example of this plays out with a private pilot with a third-class medical and a history of coronary artery disease treated with stents.  In our experience at AOPA, pilots and their cardiologists generally have no problem in complying with the FAA’s requirement for annual reevaluation with treadmill stress test, lipid profile, and a narrative report from the cardiologist.  Under our current health care “rules of engagement,” an annual follow-up examination with repeat treadmill test is an adequate and reasonable baseline study to identify possible progression of disease.

 Considering the worst case scenario under a government run “rationed” managed care system, the otherwise healthy, compliant airman with good control of risk factors who submits to an annual cardiac reevaluation for renewal of his medical certificate likely would not be covered under “the Plan” and would be denied the claim for the perhaps several thousand dollars in incurred expenses for a stress test, cardiology interpretation, lab work, and the physician’s narrative report. 

That airman would then have the untenable choice of paying all those costs out of pocket, or not be reissued an Authorization.  Our average general aviation pilot may finally say “enough” and will no longer continue to play in the aviation arena, or will, at best, opt for Light Sport self certification.  Our industry has been very resilient up to now, but in a world of a declining pilot population, forcing an additional expense on the cost of flying in the form of out of pocket medical expenses may be the tipping point for many.

 The scenario places the pilot between a rock and a hard place. The DoT/FAA won’t budge on the mandate for aviation/public safety.   So, we can’t expect that the FAA will no longer ask for an annual CT scan, a thyroid panel, a stress echocardiogram, or a heart catheterization from those airmen whose medical histories indicate such testing.  Nor can we expect that the costs of these services will decrease under managed care, as the Administration continues to claim. 

 Regardless of one’s views, it’s hard not to agree that this is a dramatically new paradigm of health care in the US, and it will be interesting to see how it plays out going forward.

Gary Crump
Director, Medical Certification Services

AOPA Pilot Information Center  |  AOPA Medical Services Program

45 Responses to “Unintended Consequences”

  1. Thomas Boyle says:

    Gary,

    Interesting to read your note – thank you. I’m glad someone has finally begun to talk about the problem of medically unnecessary testing (whether “necessary” is determined by a single government payer or not, it certainly isn’t properly determined by the FAA). FAA likes to advertise that most lost medical certificates are due to the applicant not returning the requested information: I often wonder how many of those are because the applicant couldn’t afford to do so, since medically unnecessary tests are not covered by insurance.

    Having seen Sport Pilot absorb a population of un-certifiable pilots with no statistical degradation in the medical accident rate (never mind any sort of medical incident crisis); having read many postings by pilots who are – today, in the absence of single-provider healthcare – having to pay for expensive testing their insurers (and doctors) consider “medically unnecessary”; and having personally witnessed the spectacle of a neurologist reacting to the FAA’s attempts to evaluate his patient (near fury as he wondered which part of “completely normal” the FAA could not understand), I am surprised by your conclusion that the FAA is “balanced and reasonable” in what they ask for.

    And, indeed, as you point out, the FAA has no incentive to be either balanced or reasonable: it is engaged in bureaucratic tail-covering, limited only by the fact that some of the bureaucrats are pilots themselves. We already know the actual benefit of the system is statistically indistinguishable from zero (and even if there were a small benefit, it doesn’t come close to justifying the system cost): the sensible thing, for pilots, taxpayers, medical insurers and the FAA alike, is for private pilot medical certification to go away. If it seems too much to eliminate it altogether, it should at least go away for operations of aircraft under 6,000lbs. And, given the cost, the current budget crisis should be a good time to bring this up – every little bit helps!

    You mention “unintended consequences.” Here’s one: ask yourself how many pilots you know who have decided, at least once, not to go to the doctor to investigate a medical condition because they didn’t want to have to report the visit, or the finding, to the FAA. (If you have many close pilot friends who are over the age of 35, I’ll bet it’s more than one.) Sure, it’s probably just indigestion – and who wants to have to report “chest pain” to the FAA, and deal with the fallout from that? This is bad policy: we should encourage people to seek medical help when they wonder “what was that?” rather than to say to themselves “I’ll go if it gets worse/happens again/keeps happening, but I don’t want to lose my medical for the season just because I’m stressed/tired/imagining things”. But that’s not what the system does: for no detectable medical benefit, it discourages sensible – early – interaction with health care professionals.

    Here’s another unintended consequence. AOPA used to be an advocate for expanded no-medical operations for private pilots. It was instrumental in the introduction of the Sport Pilot rule as a pilot no-medical certificate (having originally proposed the Recreational Pilot certificate as the pilot program for no-medical certification). Today, AOPA has apparently abandoned those efforts, despite the success of Sport Pilot in proving its original point. Why? Could it be… the income AOPA generates from scared pilots signing up for the AOPA Medical Services program?

    Your letter gives me hope that honest questions are getting asked at AOPA, that the organization may start to question some of the (self-serving) reassurances from the FAA medical certification group, and may return to pushing for a sensible expansion of no-medical operations to include full private-class operations with useful weights and speeds, seat counts, and night and IFR operations.

    Regards,

    Thomas

  2. Cris says:

    Gary…I thought I had imagined of all of the dark implications of this health care debacle…guess I hadn’t. Thanks for writing this; keep up the good work!!

  3. Sam Strohl says:

    I understand that right now, we don’t know the detailed coverage government mandated health care will provide. This will be shaped by those that participate in the debate. However, I have to ask about this thought, which I see repeated in many forms:

    “…one scenario of government proscribing ‘who gets what treatment and when’ has potentially serious implications for pilots…”

    Private corporations making those decisions for premium payers, based primarily on fiduciary responsibility to stock-holders, doesn’t have serious implications? It’s unlikely that any insurer is covering yearly FAA stress tests simply because the FAA requires them (except, perhaps, as an extra-cost rider). If tests are covered, it is because the insurer recognizes the medical need for such them, not the government’s. Why do you and so many others assume this paradigm for coverage decisions, demonstrated medical necessity, wouldn’t continue to be the basis for coverage?

    The government isn’t going to make any decision insurers aren’t already making. If you like what private insurance provides, it’s your task as a responsible citizen to shape the government-covered health services to meet your needs with the resources available. And unlike insurance corporations, you can actually have a voice in this. But, it sounds like you already gave that up.

    I urge all GOP/Tea Party followers to quit whining, quit shirking responsibility, and make this work. Be ingenious, not ingenuous.

  4. William J Quinn says:

    Thank you for the article, but I question the very basis of the Third Class Medical and submit it is insane in principle. After 53 years of flying single engine airplanes in military service and in my own business the government has forced the sale of my airplane because of the idiotic Third Class Medical. I can rent a large truck but cannot rent a single engine aircraft. The emporer is naked, gentlemen, naked as a jay bird.

  5. Diane Phillips says:

    I actually have a polar opposite thought on this problem. So much of the “cost” of medicine is cost shifting of the uninsured. The actual cost of a treadmill is minimal if you are not covering large back office staffs to fight with insurance and 20% who pay nothing. I suspect you would see this service done for under $500. These services are also reasonable standard of care done if a pilot or not and important to minimize more costly surgery. I am doubtful there would be additional expense. Remember the patient and FAA have aligned incentives minimize progression of disease. This is also important to an insurer who has a long term outlook unlike today.

  6. Franklin E. Fraitus says:

    Thank you for the well written piece. You were careful to include the statement “has potentially serious implications”. I understand that to mean you don’t claim it “will happen” or Obamacare is a “disaster”. You were clear, it “potentially” a problem.

    Sam’s response takes a defensive position on Obamacare. I disagree wholeheartedly. As someone who deals with local, state and the federal government regularly, the problems are stunning and “seem” insurmountable. Certainly, there are stories after stories of “actual” governmental abuse. I won’t bother to start listing them here. I have a special issuance medical, it’s a struggle to get it right. I don’t need additional layers of complexity.

    Sam, I know I have a medical condition. So, I purchase the very best insurance money can buy. In fact, the very plan Obamacare demonizes, the “Cadillac” plan. We can debate the “facts” of the Cadillac plan tax, but the facts are, it will soon cost me even more, or I can opt to get a lesser insurance. Both “government mandated” options are unnecessary and undesirable. Sam, I’m not shirking my responsibility. But, I can’t see how or why a 40% tax on my health care plan helps anybody. Do you really think I can afford this? As, I know I can’t.

  7. don wald says:

    be prepared to accept the fact that most of ga will shut down, due to govt wanting high gas prices, epa will be more involved, folks won’t have the funds, and hopefully most people will be in jail, as they will not take any insurance plan that has the govt involved. what most people don’t understand is our so called leaders want to turn america into the same crap hole countries in europe using the united nations as our guiding light! i think we should all buy bicycles and visit old airports to talk about this great hope and change fostered in by bo.

  8. Jake Suprenick says:

    We are hearing more and more about the declining numbers of pilots these days. Want to change that? Get rid of the 3rd class medical requirement for all pilots flying aircraft of 2400 pounds gross weight and under. If a pilot is not flying for money it is a stupid requirement. Restricting LSA to 1320 pounds gross is also stupid. It should be upped to 1600 pounds at least to accomodate the Cessna 150 which meets the LSA requirements in every other aspect. LSA desgination should be expanded to aircraft up to 2400 pounds gross.

    This should be the number 1 priority of AOPA if it wants to keep pilots flying and encouraging others to take it up. Everything else is secondary.

  9. Henry Brecher says:

    As a holder of a special issuance medical for the past 25+ years (for coronary bypass surgery) I am well aware of the procedures, which are in general none too onerous, although basically a nuisance. What infuriates me, however, is the ridiculously long time it takes for the FAA to review the documentation every year. This should take a week or two but usually takes at least two months. My health insurance has covered almost all of the testing and the FAA yearly requirement is probably a good thing; I’m sure I would not have a stress test every year otherwise. However, I agree entirely with the first reply (Thomas Boyle); the whole procedure is an unbelievable waste of everybody’s time, money and effort. I am reminded of the aeronautical engineer’s mantra; his job is to “simplicate and add lightness”.

  10. wsinsel says:

    Sam Strohl

    You have stated exactly what my response would have been and in a well written reply. Thanks! So much of this Obama Care panacea is executed in the Chicken Little theme.

  11. Jeff R says:

    You asked us to “let me know what you think” of your article. I think I will be cancelling my 30 year old AOPA membership. While I realize this is an editorial piece, this article was more of an expression of your personal political feelings than it was of a fact based piece that may be of any help to fellow pilots.

    Your statements about government deciding “who gets what treatment and when” are absurd. What do you think the insurance companies do now? And they do it with a profit motive in mind! Try to get individual health insurance – it’s almost an impossibility. Or, if you are lucky enough to get it, it is prohibitively expensive.

    Your views come across as anti government, very speculative, and not based in factual evidence. Insurance companies and cardiologists are not covering the examples you give out of the goodness of their hearts, or their love of flying. They view them as medically necessary or they wouldn’t cover them. How do you know the airman
    “likely would not be covered under “the Plan” and would be denied the claim”? The point is, you don’t know. I think it’s far more likely that airmen are going to be kept out of the system by the consequences of the private insurance plan than they are with a government plan. One would be more likely to utilize preventive care if you didn’t have to worry about the ability to get insurance if a doctor visit turns up something, minor as it may seem.

    Please concentrate your future articles less on your political views and more on something that may actually help grow the pilot community – like not requiring an FAA medical for private pilot certification.

  12. Lynn says:

    I’m lucky enough to be insured, but, that insurence doesn’t cover my flight physicals that I must take every six months.

    For several years I was self employed, and bought expensive health insurance with a high deductable. Most of my meager income went to flight lessons, and, I woulden’t think of going to the doctor unless I thought I was dying.

    Most people, it is my belief, who whine about national health care, probably have a nice insurance plan through their employer (the U.S. Government prehaps?).

  13. Emmett Moran says:

    My objections will not be as cool and measured as Sam Strohl; I’m too fed up with right-wing nonsense. This is your best shot at making a good first impression? Your audience is pilots, not hedge fund managers and militiamen. Your entire column seems like a regurgitation of made-up statements from disingenuous politicians during the debate. Where is your evidence for all these charges you make? And what’s with all the “quotes”? Placing quotes “around” every catch phrase or “talking point” isn’t necessary and doesn’t make unattributed “quotes” any more believeable. I don’t know what your qualifications are for the position, but I hope they go beyond being a faithful FOX News follower.
    Have to go now. Late for my “DEATH PANEL”

  14. Rich S. says:

    Another, not-so-obvious consequence of the FAA’s CYA needless medical requirements for private aviation is the ever-increasing number of pilots who simply choose not to play their game. It is common knowledge that many pilots, especially those in remote areas, no longer renew their medical certificates.

    This fact is not that obvious when using accident statistics because of the miniscule number of accidents caused by medical problems.

    Worse than “1984″ ever predicted, government oversight of every aspect of private life may bring about a Libyan-style rebellion here is our beloved country. Is it coincidental that the theme of your essay is “Unintended Consequences”, the title of a novel about just such a rebellion? I recommend every pilot find a copy and read it – twice! ISBN-10: 1888118040 ISBN-13: 978-1888118049

  15. David Adams says:

    Its already here. State and municipal governments, and other employers, under the guise of “controling costs” of medical coverage are contracting with the insurance companies – particularly HMOs and PPOs that tranditionally covered all diagnostics testing in full – to instute large deductables on “imaging” and other tests – diverting those cost to the employee.

  16. Egon Frech says:

    I don’t quite understand where the straw man of a single-payer government-run health care system comes from. It’s not what the new law establishes, as insurance covereage will continue to be provided by the private insurance companies and citizens will be compelled to buy coverage from them. We won’t be able to blame the government for not paying for our stress tests. We’ll have to continue blaming the insurance companies.

    That said, the single-payer government-run system exists in Canada, where I lived for many years, and I saw no evidence that the situation for pilots was any different than in the U.S. Mind you, I hadn’t yet had my quadruple bypass operation. Now, the FAA requires me to do the stress test every year instead of giving me a five-year pass, ostensibly because I have a non-standard EKG signature, which I have had all my life. My cardiologist uses the non-standard EKG result to justify the stress test, so the insurance company pays for it.

    But what a waste of time and resources! I would bet that a goodly percentage of currently licensed pilots in the U.S. without any documented history of heart disease could not pass that stress test, yet until they can no longer ignore their angina symptoms they can pass their pilot physical examinations with flying colors.

    If the GOP and Tea Party followers want to reduce the federal budget, I bet there are lots of areas like this that can no longer be justified.

  17. Bill Hannahan says:

    “The DoT/FAA won’t budge on the mandate for aviation/public safety.”

    Which is it, aviation or public? Forcing pilots out of their planes into their cars dramatically increases the public’s risk of being killed by an incapacitated pilot behind the wheel of his car. Medical certification for private pilots reduces public safety and our quality of life.

    The money the government wastes on third class medicals would be much better spent on bicycle helmets for children.

  18. Mike Denier says:

    I agree 100% with Mr. Boyle’s response, and in particular with his unintended consequences paragraph. If AOPA doesn’t get this solo-to-grave medical supervision by the FAA rolled back, private aviation will die. It is that simple.

    Mr. Strohl, get real. If I have private insurance I don’t like, I terminate them. That is not an option with government mandated insurance. If I decide I don’t want private insurance at all, I don’t get it. That is not an option with government mandated insurance. Gosh, I can “actually have a voice” in the government program? Yeah, just like I have a voice in Obama’s Libya war.

  19. Milton Nodacker says:

    Applause for the first column, Gary. I asked my doctor the same question and he had no answer.

    Part of the problem is the structure of the medical certificate system, based entirely on the class of lecense being exercised rather than the type of flying being done. Why should a Private licensee operating a Cessna 172 or 182 day VFR below 10,000 MSL have to meet the same medical requirements as a private pilot operating a high performance pressurized aircraft or even a light jet?

    This was addressed with the self certification provision of the light sport rule, but only for a particular type of very light aircraft. Exxpanding self certification to the same operations in other aircraft would help reduce the demand for medical services.

    Also, Sam, your last sentence is entirely inappropriate here. Save it for the political forums.

  20. Mathieu Bélanger says:

    I live, according to some, in the “Soviet Republic of Canuckistan” (Canada). We have “rationalized”, “socialized” medicine here. For everyone. Rich or poor, working or not, pilot or not. That’s the only way I’ve ever known. I’ve been holding a Class 1 Medical now for over 10 years (and a class 3 for over 16 years) in our system. Including two self-imposed temporary loss of medical due to a badly broken ankle (2006) and unexplained gastro-intestinal problems (2003). In both cases, I worked closely with the doctors involved in the treatment to swiftly regain my Class 1 medical, since flying is my career (I fly helicopters offshore).

    In Canada, whatever is not covered under “The Plan” can be covered through private insurance. What? (I hear you say) You can buy private insurance in Canada? Yes! Only for things that are not covered by the national health care plan. So if you are a pilot which has a special condition requiring testings that may not be covered by “The Plan”, all you need to do is to pay for the extra insurance. And your extra tests will be covered.

    Mind you, that “extra” insurance, in Canada, is usually significantly less than the full-blown, private coverage that my american friends have to buy for themselves.

    Socialized medicine ain’t that bad, guys!

  21. Jeff Gorss says:

    Never had a problem passing a FAA medical exam, so I have no familiarity with the concept of paying lots of money for additional testing, and never had to worry about paying for such additional testing myself. Your essay implies that others’ additional testing used to be paid for by their medical insurance. How common was that? I’ve never had medical insurance — private or, now, Medicare — that paid for any of my basic FAA medicals. Now you have me wondering, will “ObamaCare” pay for them? That would be a nice unintended consequence….

  22. Jim DeLaHunt says:

    Gary:

    Welcome to the blogosphere. As a 48-year-old novice pilot, I’m forced to deal with medical issues regularly as part of my flying for fun. I’m looking forward to reading your wisdom.

    But permit me to “let you know what I think”.

    1. Write about aviation medical issues, not about yourself. You spent three paragraphs of first impression talking about… movies, and your thoughts about first impressions. First impression: this is a column about Gary Crump, rather than aviation medicine. Next time, skip that and start by talking about a medical issue.

    2. Write about aviation medical issues, not about politics. There is a genuine issue of how the medical industry interacts with the FAA’s demands for pilots to get medical services, and that’s a great topic for this column.

    Don’t spoil it by getting facts wrong, like calling the new US health care “single payer” when it’s not; there will be many payers, including competing insurance companies and the US government. Don’t spoil it laying out essentially ideological statements like “the federal government generally isn’t very successful at running anything…”; opinions differ, about how well the US government does at what it does, and how well the alternatives have worked out for us (see 2008), and even what the appropriate scope is. Don’t segue from a real situation (new US health care law) to a hypothetical: ‘the worst case scenario under a government run “rationed” managed care system,…’; find real cases. Don’t use distorted framing by portraying the government as the only “rationer”; as Sam Strohl points out, insurance companies have for years been rationing the care their plans reimburse.

    You finally arrive at what I think is a great topic for a column like this: the tension between what medical services the FAA requires for licensing, how much those services cost, and who pays for them. That issue has one shape in the pre-2008 US medical system, and a different profile as the US medical reform takes root. But I hope you would get to issues like the evidence from the Sport Pilot medical rules, the incentives for the FAA to ask for more and more medical services as unfunded ass-covering, and the incentives for pilots to deny themselves medical care rather than facing the choice of lying to the FAA or jumping through hoops after reporting it. Don’t leave it to readers like Thomas Boyle to bring them up.

    There are plenty of politics columns on the web. Some of them are even well-researched and informative (hello, Andrew Sullivan and James Fallows). If that’s what you are writing, my plate is full, I won’t stay. But if you’ve got aviation medical topics to explore, I’m with you.

  23. ED K. says:

    In response to Thomas Boyle:

    Congratulations Mr. Boyle. Your succinct and well reasoned reply to Mr Crump’s attempt to make a good first impression is greatly appreciated. I too hope that our advocate AOPA will continue to work for sensible medical regulations pertaining to private pilots.

    Thank you,
    Ed K.

  24. Dean Winslow, MD says:

    As a physician for 35 years, ANG flight surgeon for 30 years, and pilot for 44 years with ATP license, I think I’m qualified to raise the “BS flag” on many of the assertions in the “Unintended Consequences” piece above. In the U.S. we spend more than twice what the next highest-spending country does on health care yet we are far down the list in terms of our health outcomes. I submit that the Affordable Care Act (“Obamacare” as the Tea Party/Fox News crew calls it) does not go far enough in terms of looking at cost-effectiveness of medical interventions. FAA often lags a little behind what “state of the art” may be regarding testing required to support waivers for certain medical conditions and tends to be conservative, but in the end is generally reasonable and actually listens to their medical experts. I have always felt that being a pilot is a great privilege and responsibility (as well as a very unforgiving activity where our passengers are dependent on our health and aviation judgment) so I don’t think it is wrong for pilots with certain medical conditions to have to pay extra on occasion for diagnostic tests required by FAA to support a waiver.

  25. Matt Whitis says:

    I could not agree more with Sam. As a physician I am tired of the rhetoric about the “government takeover” of healthcare. We have had for profit private insurance takeover of healthcare for so long that no one seems to think there is any other way. I think the tea party/GOP faithful are somewhat amnestic as to how bad the current healthcare deivery system is and how little they have contributed to a potential solution over the years. Why not a system that focuses about the quality of care not just volume of care? How about a system that provides basic healthcare coverage for everyone? How about a system that wont bankrrupt the country as the current system is certainly going to do? It is easy to pick apart the “unintended consequences” of “Obamacare” but why hasn’t any state taken up the challenge to cover as many lives with the same cost with a different plan? I for one am tired of seeing young people die as a consequence of no healthcare insurance. I am tired of bankrupting people who come to my Emergency Department because they could not get insurance or have lost coverage. I am not afraid of insurance reform. I dont fear the government and it’s motives any more the indurance industry and it’s regulations. I know the goverment cares more about people than the insurance companies who need to please their stockholders and try to justify their million dollar bonuses. Most other countries seem to have this all figured out. Why can’t we? I am with Sam. Stop whining and work toward a soluton or get out of the way.

  26. Grumpy says:

    No one has yet managed to explain to me in words of one syllable why a simple letter from one’s cardiologist would not qualify a VFR private pilot from obtaining a one-year special issuance third class medical. Do the doctors at Oke City really think that they can better judge a pilot’s medical condition than his own physician?

  27. Allan O. says:

    Gary,

    Your politics are obvious.
    Rather than bashing the Affordable Care Act why not go to the source of the problem, the FAA’s requiring medical followups
    when they are no longer needed.
    And then there’s the ridiculous situation of the sport pilot being able to fly with a driver’s license but the 150/152 private
    pilot needing a 3rd class medical certificate. Why not, as suggested by others, eliminate the medical certificate for private
    pilots flying non-high performance aircraft?

  28. Anonymous says:

    I heard that the government may shutdown tonight. What will happen to the FAA’s medical department after the shutdown is over? Will they get rid of the 3rd class medical for Private Pilots, Recreational Pilots, and Sport Pilots (if their medical was denied) because it costs too much money for the FAA?

    Also I heard that AOPA sent a list of recommendations to DOT/FAA for Obama’s Regulatory Improvement and one of the proposals was a Driver’s License Medical/Self Certification replacing 3rd class medicals for Private Pilots. What is the chance
    of the FAA taking that proposal?

  29. Grumpy says:

    Probably slim to none. It makes far too much sense and dosen’t require 23,000 government employees to administer.

  30. Thomas Boyle says:

    All,

    In my original post I suggested that AOPA might be dropping the ball on pushing for no-medical operation beyond Sport Pilot, possibly due to the income it generates from its heavily-publicized Medical Services Plan.

    However, I see that AOPA has not dropped the no-medical recreational-use idea, and has made a submission to DOT proposing exactly that (see http://download.aopa.org/epilot/2011/110406regs.pdf).

    I want to recognize AOPA’s action, commend the organization for it, and urge members who agree with it to communicate their support for this move to AOPA. I hope AOPA will continue to vigorously pursue this sensible objective, whether through this initiative or (if not successful this time) through other initiatives.

  31. Gregory Pinnell, MD says:

    Gary: I agree with some of what you said but I take a different perspective of the third class medical. The third class medical does alot more than just “rubber stamp” a certificate for the private pilots next two years of flying. It gives the pilot a chance to talk with someone who can help them make decisions about future flying and also what of their medical conditions can and cannot be aeromedically signficant. Human factors issues can be discussed with the airman at the time of the medical as well. It also can prevent catastrophe in and out of the cockpit. From the pilot with an undetected heart murmer that required almost emergency surgery to save their life, to the 70 year old pilot who was going to fly Young Eagles 2 weeks to being released from the hospital after a stroke to the family who called and begged me not to certify their father who was openly suicidal on multiple psychiatric medications and was going to lie about them. These are just a few examples. There are many, many others. I think improvements streamlining the medical process is essential but dropping the third class certainly will not lead to improvements in aviation safety. If the future of GA hinges upon the removal of a $65-70 flight physical every two years then we are in more trouble with our avocation then we know.

  32. Thomas Boyle says:

    Gregory,

    No offense, but as the old proverb says, “never ask a barber if you need a haircut.”

    And, as the French economist, Bastiat, pointed out, you should not consider only what is seen, but also what is unseen. For every one of your examples, I have no doubt there are several pilots who suspected they had problems but did not seek medical help, for fear that in doing so they might endanger their medicals. Thus, they never spoke to a doctor, and had no opportunity to make an informed evaluation of the risks they were taking with their own lives – and others’. I have no doubt that lives have been lost as a consequence – ironically, almost certainly on the ground, not in flight, since even when a disabling event does occur, the odds are greatly in favor of it happening on the ground. You don’t see those cases because… they didn’t come to you with their worries in the first place.

    That’s not surprising: your belief is based on what you see, not on what you don’t see.

    If you want to ensure that pilots have had a conversation with a doctor about their health and how it applies to flying, maybe that’s what the 3rd class medical could require: “I, Dr. So-and-so, am aware that Person Thusandsuch is a pilot, and have had a conversation about his/her health in that context.” That’s ensuring a conversation; the rest is creating medically unnecessary cost and disincentivizing the very conversation you hope to see happen.

    Cheers.

  33. Carlos Pereyra says:

    Raise your hands, any of you who think that paying $1000 for a medical is “untenable” and own an airplane worth $100,000 or more.

  34. Terrence Bolls says:

    Sorry, Carlos — I rent. And it’s not just the thousand bucks, it’s the thousand bucks over and over again before I even start the preflight.

    It has been more than sixteen years since I last flew as a pilot. The lapse was caused by the loss of an entire career that was more than 22 years in the making (the new broom, a “fresh face” CEO, swept clean indeed), first-time fatherhood at 51 (love it!), and rebuilding a family-supporting career from scratch. In that time, I have enjoyed the “benefits” of every good and bad health insurance plan out there (/Snark).

    I would love to be flying again, but I find myself more in agreement with Thomas Boyle than with any other respondent to this blog.

    I don’t fault doctors for the $100-plus cost of a 3rd-class medical ($65-70? I had a good laugh over that one. The one I had 16 years ago was more than $100). Four years ago I had a quintuple heart bypass, and I’ve tried my best to be a good patient. I eat right, exercise daily, and every Friday I perform a Bruce Protocol stress test to and including stage IV.

    In a few months, I’ll be 65 and will have to go on Medicare for my medical insurance. That may or may not cause me to encounter major changes in who and what gets paid for by medical insurer.

    It’s not just the high cost of having a doctor-monitored stress test or thallium stress test that gives me pause about trying for a Special Issuance; it’s (1) the fact that I have to do it again next year, and the year after that, and the year after that . . . and (2) that’s not the only condition I have that will have to go through Oklahoma City. Since the last time I flew, I had a kidney stone; it was more than ten years ago, and there’s never been another. But it appears that I’ll have to answer for that one too, over and over again. Not to mention that I’ll have to dig deep to find all the doctors I’ve seen in the past three years . . . I fear I’m facing an annual entry fee of more than a thousand bucks before the Hobbs meter ticks off the first second of engine time.

    Much of the literature about keeping a medical focuses on getting it back the first time; but little is said about the exams that come later. Also, little is written about the process for pilots with multiple issues.

    AOPA’s suggestion to the FAA that Private Pilots flying VFR only use a driver’s license as their medical is a great one. Wanna go one better? Hold “keep your medical” clinics! The FAA should do it at every Wings seminar, too. I wouldn’t mind paying $100 or even $200 if I knew I could get everything done during an evening’s time, with a strong chance of success. I understand Dr. Pinnell’s point of view as well, but I think his examples have little to do with third class medicals; I’m glad that the good doctor was able to act before disaster happened, but in every case I’m not sure the existence of a quarter-sheet of paper (or lack thereof) was what kept that pilot from flying.

    Flying is something I’ve missed terribly. I want to be upstairs again, and soon.

    In the meantime, I’m with Mr. Boyle. Regardless of whether I can pass a Special Issuance, I’m likely going to support Sport Pilot – I think I’m a good risk (and so do my cardiologist and my regular doctor as well, I’m not doing this alone), and the more good risks flying in Sport Pilot, the better.

  35. Carlos Pereyra says:

    Hi Terrence,
    I’m much in the same boat as you, age and health wise. Maybe there should be a government voucher issued to pilots who make less than $250,000 to help with the cost of the medical (yes, I have socialist tendencies :-) The others, can pay the doctors themselves. In any case I wish you the best of luck and health.
    Carlos.

  36. Terrence Bolls says:

    Hi Carlos,

    And the same regards right back to you, sir. Also, too, I don’t think of it as socialist tendencies so much as spreading the happiness, like insurance spreads the risk . . .

    I remember an episode of The West Wing where a man in an airport bar in Ohio was talking about putting his kid through college, and he said that although he was happy and comfortable, he thought it should have been just a little easier to do.

    Yeah, me too. Keep it up AOPA, you’re doing great. Today I’m writing my dues check, the 25th in a row that started in 1987.

    Terry

  37. Steve says:

    Do you want to

    Reduce the unintended consequences?
    Increase the pilot population?
    Save airports?
    Help solve the aviation fuel issues?
    Boost new and used aircraft sales?
    Create jobs?
    Cut government spending?
    Grow AOPA membership?
    Increase political clout?
    IMPROVE the overall health of the pilot population?

    Eliminate the third class medical for private pilots.

  38. Terrence Bolls says:

    Wow! Well said, Steve.

  39. robert says:

    Can we get a new blog to replace this rubbish?? I normally enjoy reading these blogs. If i wanted to read about fantasy and fiction, I go to the library. When I want to read something about aviation I go to only a few websites for information. This is one of them. If you want to spew such smut, by all means, do it, but do it on the proper forum. This is not it. If you want you should get on a tea bagger forum and belch as much nonesense as you want…but save this forum for facts and actual aviation related stuff…pretty please?

  40. Lloyd Emberland says:

    My only hope for the future of general aviation is that the 3rd class medical will be loosed up when the FAA realizes that there is not any statistical difference in accident rates between LSA pilots and those with 3rd class medicals. So far insurance companies recognize no difference so premiums are the same. Some pilots won’t report health issues to their personal doctor for fear their 3rd class medical would be denied. Aircraft insurance could then be denied in the event of an accident if one was to falsify a medical record to one’s AME. The LSA rule eliminating the 3rd class medical makes a lot of sense and it is now time to expand the rule to cover more aircraft.

  41. Robert says:

    Dont forget….lsa doesnt exactly eliminate being medically fit for light sport. If you have reason to beleive you are not qualified for a medical, you cannot just “go” light sport. I suspect there will be much in the way of enforcement when the FAA realizes that its effort to grow the population has allowed a great many people who know they are not medically fit for flight to simply “fly lightsport” as the prevailing miswisdom says.

    • John says:

      The 3rd class medical can be shown to be a highly disproportionate risk mitigation, in terms of cost/benefit ratio . Consider this: It is estimated that outright pilot physical incapacity is responsible for about 1% of general aviation deaths. But, let’s be pessimistic, and say 5% of GA deaths are from pilot physical incapacity. Since there are only about 600 total deaths in all of GA per year, that works out to 30 deaths a year due to pilot physical incapacity. To put that in perspective to other risks, consider that about 50 deaths a year are due to lightning, 400 per year from falling out of bed! (should we have federal bed inspectors?), 740 from bicycle accidents (do we need federal regulation of bicycles ?), 565 from falls on level ground or floors (federal walking instruction anyone?), etc. etc. And of course there are 40,000+ per year deaths in automobile accidents. But if we stick to the 1% figure for GA deaths, then there are 6 deaths a year due to pilot physical incapacity! Does either figure warrant a federal bureaucracy administering the 3rd class medical ? There are innumerable other causes of death with far greater fatality numbers than due to GA pilot incapacity. The number of fatalities due to pilot incapacitation are truly infinitesimal when compared to other causes of death. When these relative statistics are seen in perspective, the obvious absurdity of the hyper-zealous medical 3rd class exam can be seen. Having an entire federal bureaucracy to harass private pilots with the 3rd class physical is a huge mis-allocation of time and tax-payer money as well as an infringement on our freedoms.

  42. Steve says:

    YES! The FAA must do something! The countryside is becoming littered with the wreckage of aircraft brought down by medical incapacitation. When will this carnage end and the government protect us from lunatic pilots! The very fabric of America is being ripped apart and if the FAA won’t do something then Homeland Security should!

  43. Lloyd Emberland says:

    Don’t forget that every flight made by pilots must self certify their condition whether ATP or LSA. Insurance
    companies base their rates on the risk to them and consequently the payouts for accidents based on statistics. My
    insurance agent said their is no statistical difference between LSA and 3rd class medical holders. The LSA rule is
    now about 7 years old. There is no evidence of airplane accidents littering the country side due to medically unfit
    pilots. Let’s stick to the facts.
    Let’s hope AOPA will do the right thing and lobby for loosening up the LSA rule.

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