Cheers! Top view of people holding mugs with beer.

Budweiser manufacturing is an unbelievable process. The fermentation of grains into alcohol is an ancient art and holds its own bit of magic. Budweiser puts those little yeast cells hard to work, churning out 2.5 billion cans of brew every year.

But what makes Budweiser truly remarkable is the consistency they can wring out of a completely biological process. Yeast changes over generations (which, when you are a yeast, happens every 80 seconds), water sources change from location and, over time, factories have ever-changing microscopic contaminants. But, year after year, Budweiser is the same – if you drank a Budweiser in Bangkok today, it would taste exactly the same as a Budweiser in Boston in 1985.

One process engineer speculated about the consistency this way:

“[Anheuser-Busch] most likely uses a PLC to automate their breweries and have all their breweries on some sort of central network to monitor every plant and collect data 24/7. They also most likely compare statistics of all their plants against each other. They’ve also been doing it long enough with exact records to predict issues before they’re present and can design a brewery for consistency. I’m also pretty sure their suppliers also must provide statistical data on their products and have their processes certified by [Anheuser-Busch] in a way not much different from the automotive or aerospace industry. They’re also most likely practicing six sigma and using statistical process control.”

Budweiser published this additional insight:

“Even after the beer has been made, it must pass inspection by a panel of testers made up of St. Louis Brewmaster Joel Boisselle and his fellow brewers. Each day at 3 p.m., they taste for any potential flaws, comparing beer from different tanks to ensure consistency across the board. Though automated testing might be able to determine color or carbonation, highly trained humans are able to detect more subtle discrepancies that no machine can. Even the water – some of which might not go into beer, but is used to wash bottles, tanks, and equipment – is sampled obsessively to ensure that it’s always free of impurities.”

Quality control by humans and machine make the amazing Budweiser consistency possible.

And we have those examples throughout our economy. New pairs of jeans have the “inspected by” sticker because the manufacturer has a person go through each pair individually before it is shipped. Phone manufacturers invest in laser scanners to find defects in the microns. In fact, if you look at the defect rate across all consumer products globally, $168.3 million of consumer goods are returned for defective or poor-quality products out of $14.5 trillion consumer goods1. That’s an estimated 1.1 percent failure rate at the consumer’s end.

The famous Institute of Medicine study reports that U.S. health care has a defect rate of 30 percent, or $750 billion, a magnitude three times higher than all the consumer goods in the world. Three out of 10 of your health care plan members are being misdiagnosed. Seven out of 10 are having orthopedic surgeries that are not indicated. There are a lot of culprits here, but an addressable issue is the treating provider’s lack of quality feedback.

If a $3 can of beer of trivial health risk (skipping all the caveats about moderation and heavy machinery) is worthy of an inspection, why isn’t a $120,000 back surgery that can cause paralysis or death? Health care needs the same Inspector #12 that ensured that the hem on my jeans was stitched correctly.

Referring back to Budweiser: Medicine has clinical evidence that reliably produces optimal outcomes. Is this not analogous to the Six Sigma controls used in the biological process of brewing beer? Medicine is an art just like beer making is an art. Where is medicine’s 3 p.m. taste-test meeting of well-trained doctors who can pick up “subtle discrepancies” to ensure the care is right?

We move around risk and we can move around who pays for what, but we aren’t addressing the problem. Plan sponsors, the stewards of health plan spending and employee health, should put the tools in place that meet or exceed the same standards we demand from our jeans and our beer. Maybe it’s too tall a task for every clinical interaction. But, certainly, invasive procedures and expensive pharmaceuticals should be an area of focus for optimal impact, financially and for health outcomes.

It’s ridiculous that your members are safer drinking a Bud than going to their doctor.


1. Consumers return $642.6 billion in goods each year. June 2015. https://www.marketwatch.com/story/consumers-return-6426-billion-in-goods-each-year-2015-06-18.