The airline industry provides a gloomy metaphor for health care, according to Brandeis University economist Stuart Altman, who spoke at a W. P. Carey School of Business symposium recently. With hospital care dominating the growth in health-care costs, institutions that can focus on the patients and procedures covered fully by insurance will be robust. Hospitals that serve the poor and the uninsured will falter –- like big airlines committed to providing ubiquitous service, even in unprofitable markets. With the baby-boom generation aging into high utilization, pressure on the system will only increase. Altman outlines the hard decisions ahead.