Love the analogy. Yeah, it seems like that. That is why it seems only VW will get penalty in the end, which is, at least to me, surprising.
I suspect that only VW will directly be penalized for 'cheating on the test'. I think that as some of this real world testing is happening, regulators are learning(?) just how big the disparity is between reality and studying for the test, and will change the parameters of the test to reduce the gap between reality and the test.
To the extent that the test changes to minimize that gap, all manufacturers (well - all gas/diesel engine car makers anyway) will feel that pain and have an incremental expense. And we'll all breathe better (eventually) for shrinking that gap.
The way I look at it, I'm comfortable if there's even a 2x gap between test performance and real world performance. 2x and down is at least within my own experience of how much I can vary the range on my Roadster based on how much lead I have in my boot that day, driving conditions, sprinting up hills, etc.. But 10x emissions, or passenger autos with higher emissions levels than trucks hauling stuff - that's not ok and it's not close.
So I don't expect the tests to be perfect - it's in the nature of a test to measure something specific in a controlled and repeatable fashion. But the test can be designed with a smaller delta between test and real life results. For eye.surgeon's analogy, it makes the test more useful. Who wants to hire somebody whose performance drops 10 fold over their test results?
