The key lesson of the United Airlines fiasco has nothing to do with airlines

Chicago, as seen from non-United flight

Last Sunday, a security officer dragged a 69-year-old physician, David Dao, off a United Airlines plane at O’Hare Airport. Dr. Dao was injured in the altercation. The extent and severity of his injuries remains unclear, but are likely to receive close attention when he sues. Video of the incident ignited an internet firestorm.

The past week has occasioned thousands of tweets, countless newspaper op-eds and commentaries about how lousy airlines generally are, and how United Airlines in particular needs to raise its game.

A week later, I fear the real lesson is being lost.

So much of this commentary tied into that iconic middle-class grievance: the indignities associated with economy-class air travel, and the emblematic disparities between the lousy bag of peanuts provided in Coach and the lavish amenities provided behind the curtain in business-class and coach.

Although I wish United Airlines gave better service, I’m not feeling the same sense of grievance that wealthy airline passengers pay hefty premiums for visibly better and more lavish service, tiered airline fares and service may be the least harmful expressions of inequality in American life. After all, we all board the same plane operated by the same pilot. We all arrive at almost exactly the same time. And some sucker in business class helps cover fixed-costs for the flight by paying $500 more than I do for the privilege of a nicer meal, a hot towel, and an electric outlet. Even the overbooking serves an important economic purpose, too.

I kindof wish we had the same tiered services in American healthcare. The rich patients would have nice private rooms with magazines and nicer food. Maybe Hospital Singapore would appeal, Fox and Friends style, to rich people by hiring pretty young women staff for the fancy rooms. Meanwhile the poor people would have grittier waiting rooms with Jenny Jones on the TV. You might share a room with a talkative patient with an annoyingly loud family. But rich and poor people alike would go to the same hospital, have their critical operations performed by the exact same surgeons, who would have almost 100% perfect safety records. Everyone would receive equally proficient postoperative care, and poor people would pay markedly less.

The big problem last Sunday was much simpler than bad service. A passenger and the airline had a disagreement. The passenger sat there and refused to leave. Most people believe Dr. Dao was in the right. He was already on the plane. He had patients to see. He had understandable reasons to be upset.

Loop as viewed from the same non-United flight.  Yeah de-hazing messes up the white balance

Who was right is basically irrelevant. United initially claimed Dr. Dao was belligerent. They later backed off that claim. Dao apparently had some issues with his medical license, prompting the sort of “he’s no angel” stories one expects when young minority men get into it with police. Dr. Dao was noncompliant, maybe angry and belligerent. But the important fact is that he was just sitting there, posing no physical threat to anyone. Security staff made a tragic mistake by putting their hand on him, even if he were belligerent, and even if United was completely justified in asking for his seat.

My own work includes efforts to help police deal more safely and effectively with individuals in behavioral crisis. Our society expects officers to act with remarkable restraint in their encounters with individuals who display much more frightening behaviors than Dr. Dao did, in far less controlled settings. That’s a huge challenge when officers are called, for example, to a street corner to calm a severely-mentally-ill man waving a baseball bat. In such difficult situations, it’s crucial for police to effectively deploy time, distance, and cover to keep everyone safe, not least the person in behavioral crisis and the officers themselves.

As the caretaker of a 260-pound intellectually disabled man, I have more than a passing interest in these issues. ’m unusually sensitized to such dilemmas. Consider the case of Robert Ethan Saylor, a twenty-six-year-old man living with Down syndrome. Mr. Saylor and his attendant went to see Zero Dark Thirty at a Maryland theater. After the movie was over, he returned to his original seat without paying to watch the movie again. He was asked to leave. He becoming increasingly agitated and belligerent, and refused to leave. Against the advice of Mr. Saylor’s attendant, the theater manager called three off-duty sheriff’s deputies. They quickly got physical, trying to drag the 300-lb Saylor out of his seat. He ended up pinned under them in cuffs. He suffered a fractured larynx, and died.

Robert Saylor’s was an extreme case, but hardly an outlandish one. And the physical setup on that United plane reflected a reasonably common dilemma facing law enforcement. Let’s imagine United Airlines was completely justified in asking Dr. Dao to deplane, and to ask security staff to evict him. Things didn’t have to play out as they did.

I’m not particularly bothered that airlines occasionally bump passengers from overbooking. Although bad airline service is a genuine problem, it’s pretty low on my list of matters requiring urgent policy attention. The important thing is that someone got hurt. And this was so unnecessary, too.

Imagine these officers had stepped back to handle the situation differently. Perhaps they could have appealed to the other passengers: “This gentleman obviously wishes to stay. Can someone, anyone, here do me the personal favor of taking the same $800 to get on the next flight. That way, we can all get on with our day, with no one the worse for it?” Perhaps, if that didn’t work, they might have upped the financial ante. Or they might have found some other solution.

Police sometimes need to use force. That’s justified to keep people safe, not to ensure someone’s compliance with some airlines overbooking algorithm or passenger service agreement. When police put their hands on an agitated noncompliant person, things can go sideways horribly quickly, sometimes with more horrible and permanent consequences than the public humiliation United is now experiencing. That’s a much bigger and more urgent concern than the crummy service and overbooking one might experience in coach.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

18 thoughts on “The key lesson of the United Airlines fiasco has nothing to do with airlines”

  1. I've said it before and I'll say it again. When the police are called into a situation where no crime has been committed (and I suppose United could claim that a trespass was in progress, but let's put that aside for now) and end up making an arrest, it is a sure thing that they handled themselves badly.

  2. Lowry is correct. At best (worse?), Dr. Dao was guilty of a breach of contract. The police should never intervene in a contractual dispute unless and until the dispute has been addressed by some neutral magistrate.

    BTW, the difference in perceived treatment between first class and the rest of us has long been around. The late comedy team of Wayne and Shuster (who hold the record for most appearances on the Ed Sullivan Show) had a comedic skit about the difference well over sixty years ago.

  3. Harold's two-tier hospital rooms exist already in Europe. In the UK, the better-off get their flowers and single room in a BUPA clinic; Saudi princes and the native rich can check into the London Clinic. In France, the Sécu usually gets you a shared room (two or three beds, not a Florence Nightingale huge open ward). The middle class have complementary insurance, often from their employer, that buys a single room. In my experience, you rely on family and friends for the flowers. These inequalities are accepted because when you get to the operating theatre, rich and poor get the same care. The one medically substantial difference is shorter waiting times for private patients.

    1. Outcomes of surgery are the same between VAs and their academic affiliate hospital, the latter just tend to look more nice — which as Harold says is not something to worry about.

      1. There are more goals to medicine that the patient's surviving the operation and the ICU. Anecdote: when my first wife's oncologists told her there was nothing more they could do and her days were numbered, her bed in the brand-new university hospital, designed by an insane architect, looked out on a sunless courtyard all in battleship-grey steel, suggesting a supermax exercise yard. I paid a lot to fly Pat to a Nuffield private hospital in Brighton, with a nice room and a great view over the Downs to the sea. The bonus was a pair of estrels nesting under the eaves. Permitting Pat to live out her last week in good surroundings was the best money I ever spent.

      2. There are more goals to medicine that the patient's surviving the operation and the ICU. Anecdote: when my first wife's oncologists told her there was nothing more they could do and her days were numbered, her bed in the brand-new Strasbourg university hospital, designed by an insane architect, looked out on a sunless courtyard all in battleship-grey steel, suggesting a supermax exercise yard. I paid a lot to fly Pat to a Nuffield private hospital in Brighton, with a nice room and a great view over the Downs to the sea. The bonus was a pair of kestrels nesting nesting under the eaves. Permitting Pat to live out her last week in good surroundings was the best money I ever spent.

        1. When our foster daughter was diagnosed with cancer, her first oncologist's office had a big room out front where people sat in a circle of recliners getting chemo. It was spartan and drab, and I'm not sure there would have been room for both me and my wife to sit with our daughter during chemo. When they found the cancer was metastatic, she got a new doctor who practiced out of a state-of-the-art hospital (with a huge Chiluly sculpture in the lobby). There, each chemo patient had a private room that could hold at least three people, with comfy chairs and wi-fi. (I think they had TVs too.) Snacks right outside the room, and plenty of caring nurses and aides who would respond instantly to any call. (Our daughter had insurance; good insurance, as it turned out.)

          Thinking about it now, the second place is probably too much to expect for the richest nation on earth, the greatest nation God has ever blessed, etc. to offer universally. And let's face it, if we had wound up at the more spartan place, we would have been grateful for the treatment. Plus, the second place was probably fancier than it needed to be, though I'm sure the Chiluly and other fancy amenities were partly to make the donor feel extra good about his charitable act.

          But, if the first place had just been designed with a focus on humanity rather than minimalist utilitarianism, it wouldn't have been any more costly to build or run. In the US – and the UK, in my limited experience – it seems there's a conscious desire to make sure that the less fortunate are constantly reminded of their lack of fortune. You don't deserve nice things, even if they're not expensive. It would be too much contrast to the crumbling and broken stuff in your everyday life. A window that looks out on something other than HVAC units can't cost that much more than one that finds some kind of view. More homey surroundings are not a health hazard, nor are they more expensive. Treating humans like humans should be a baseline expectation, not an indulgence.

          1. Some things are quite cheap. My father-in-law was once in a pretty generic NHS district hospital in Leicester. The corridors were full of paintings. It turns out there's a British charity that buys original art from young painters by the truckload for hospitals, and rotates it. The quality varied, as you'd expect, but there was a fair share of stuff worth looking at. Even the second-rate is humanising. The room on the cardiac ward was too crowded with gear for pictures, and I dare say there may be cleaning issues too.

            BTW, research has been done on the medical efficacy of prayer (unproven IIRC). It should be possible to find out if flowers make patients better. The analytic problem is that flowers are brought by relatives and friends who visit, and their expressed concern presumably does make a difference. The control group would have to be patients who were visited just as often minus flowers, perhaps for some medical reason or hospital policy.

        2. There are more goals to medicine that the patient's surviving the operation and the ICU.

          I did not know that — fascinating to learn, had no idea, never occurred to me.

          1. Unfair. Harold and you opined that a nice environment in hospitals is medically unimportant. I disagreed, on any broad view of their true goals. These include offering a good place to die.

          2. I think there are some assumptions (perhaps accurate) that could use unpacking here. In general, the more expensive places will look nicer, have more space etc than the cheaper places. But. Some of the cheaper places (and some of the — sometimes older — expensive places) cross the line from less-nice to actively patient-hostile. (And visitor-hostile as well) There's a difference between accepting the fact that luxury medicine will generally have more amenities than non-luxe and being OK with non-luxe as something out of a dystopia.

            (Anecdote: shortly after our first kid was born and spent 6 weeks in a NICU far from home, we happened to see the NICU that he would have gone to, had his emergency c-section not happened on vacation. It was at a newer hospital, much better equipped and staffed, but designed much more like a factory floor. I came away with a strong belief that he would have died if he'd been treated there.)

  4. The French railway museum in Mulhouse has carriages from the earliest days of rail travel in the 1840s and 50s. The first class travelled in ludicrously padded and over-decorated luxury, the poor in third class on hard wooden benches. The gap in rail has shrunk since, and first basically just buys you more space (and in Eurostar, a decent meal served in your seat). The current class gap in aviation is on a Victorian scale.

  5. Another elephant-under-the-carpet issue here: policing is inextricably and sometimes horrifically tied to control and what happens when (not if) a law enforcement officer loses (or never had) control of a situation.I'm profoundly aware of what terribly conflicting imperatives a LEO faces: self-preservation, self-sacrifice, compassion, utterly ugly people and situations, and on and on…..which they must somehow Make Right. Unfortunately, we don't train or pay anything like what is needed to deliver this paragon…so we get odds and sorts that often, when the situation is out of control, go bull-in-the-china -shop. They may even get off on it. Control is established…amidst the wreckage and injury and death. Of course, minorities have always understood they may likely be abused. Perhaps this brave new world of democratized misery now involves the rest of us…and we find we don't like it all that much.

  6. "Who was right is basically irrelevant." Well, it does matter in the sense that if the Chicago aviation police had understood the relevant law, they could have told United that there was no legal basis for removing passengers from the plane. My guess is that the police just instinctively sided with the airline rather than trying to evaluate the merits of the dispute.

  7. My lesson from this incident is that if they tell me to get off the plane, I'll swallow my ego and get off the plane.

  8. "…When police put their hands on an agitated noncompliant person, things can go sideways horribly quickly…"
    No, even this is not the problem. The problem is that no matter how sideways things go, it is (today and for the future) unthinkable that police would ever face accountability. And this applies *equally* to interactions with persons who are not agitated, not noncompliant, not minorities, etc. etc., all of whom (can you see them in their millions crowding behind me?) thank you for throwing them under the bus.

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