By Matthew Holt

Five years ago today, without really knowing what I was getting myself into, I wrote the first post on The Health Care Blog.

If you forced me to come up with a reason why, I would have told you that I thought that a blog would give me a chance to build my nascent consulting business — although I think the process was actually more useful to re-educate me about health care. I’ve never calculated the time spent on THCB, but I’m pretty sure it hasn’t been a rational financial decision.

The first post was about what was wrong with Medicare (and it’s still equally valid today and probably will be equally valid in 2013!) For the first little while I tried hard to maintain an analytical air about the future, while trying to avoid giving overt opinions. It took me a month before I started editorializing, even though the first one was introduced in a mealy mouthed way—as I somehow didn’t trust people to distinguish between what I thought ought to happen and what I thought was going to happen. But that didn’t last too long, thank heavens.

For the first year or so I was probably writing for myself and about 3 other people. Back then Russ at the late lamented Bloviator was writing about public health, Don Johnson also was writing about health care at The Business Word (Don left blogging but made a comeback and has been an occasional contributor at THCB). Back then my two favorite medical bloggers were MedPundit (who left blogging then came back then eventually left again), and DB’s MedRants who’s still going strong. And of course, although it took me years to find, Mr HIStalk had already staked out the hospital IT market. But in all honesty it took a long while before anyone took us seriously.

Now, the WSJ and New York Times have health-related blogs, and over 800 are listed on the Healthcare 100, even if THCB has fallen a few spots since their recent recalculation! While I’d argue that many of the 800 are not much about health care, but about science and fitness, and that the ranking is pretty arbitrary, there’s no question that—as in technology and politics—health care has been changed by blogging.

In fact THCB has been involved in some of the big debates about the future of health policy, and I’ve had the chance to meet some policy movers and shakers I’d never have met in my old consulting life. Heck, Paul Krugman even devoted a page to THCB in his latest book! (I, of course, only found out when a friend sent me a copy with a note about it!). Nonetheless, I’ve had fun meeting liberal journalists like Jonathan Cohn, libertarian think tank guys like Michael Cannon, and have interviewed a cross section of the intense (Shannon Brownlee), the too-nice for their views (David Gratzer) and the right-wingers barely hanging onto to reality (Grace-Marie Turner). Not to mention lots of fun with early day podcasts with libertarian surgeon Eric Novack, who still makes the odd appearance here.

THCB has also given me and many others the opportunity to see some real changes in health care. The biggest for me personally has been the front row seat I’ve had in the development of Web 2.0 in health care (yes, yes, it’s called Health 2.0). What started as few small conversations 3 years ago has blossomed into a movement, and also for me and my partner Indu Subaiya, a day job! But there are lots of developments that have been covered on THCB and debated by its community, including quality, patient safety, EMRs, HSAs, individual insurance, cost-effectiveness, pharmaceutical marketing, PBMs, technology, and many many more.

And THCB really has changed into a community. Over the years, there have been many regular contributors, including those like Matt Quinn and Brian Klepper who’ve taken over the blog while I’ve been away, and contributed immensely at other times, too. And more recently, THCB has been a venue where other bloggers show some of their best stuff — I want to thank those like Jane Sarasohn-Kahn, Maggie Mahar, Bob Wachter, Paul Levy, Scott Shreeve and several others who let us feature their writing. It’s now very much a group blog — although it was only this year that I started to give my own pieces a byline rather than just assuming that everyone knew it was me! Now I’m happy to be just one of the crowd.

Moreover, THCB has always enjoyed lots of comments. Some are from people passing by just once or twice, but others like Tom Leith, JD (no, not JD Klienke), MG, Peter, tcoyote, Barry Carol and many more have come back time and again to comment and add really valuable insight. Some commentors are gone and much lamented (Theora Jones), some are gone and less so (Stuart Browning) — meanwhile, anyone want Ron Grenier back? Ron remains the only commentator banned from THCB (for outright rudeness), which I think underscores how great the tone of the discussion has been, despite the clear differences of opinion amongst the commentators.

So I want to leave you with two last thoughts.

First, what’s next? Well over the course of the next few months THCB will be continuing to evolve its look — there’ll be more content, more authors, more great debate, and more ways of finding that content. We’re going to be making some changes to the front page and some definitional changes to both make the sections clearer and make some of the best “perennials” easily visible. THCB now has its first professional editor/author, Sarah Arnquist, whom I hope will be using THCB as a stepping stone to her future Pulitzer Prize. She’s a journalist working at THCB while pursuing an MPH at Johns Hopkins. We’ll also be making it a little easier for advertisers to sponsor appropriate sections of THCB. Yup, while THCB has never directly made me a penny, it is finally showing the potential to be a real media site, which brings its own opportunities — and pitfalls.

Second, THCB’s great run wouldn’t have been possible without lots of help. I can’t possibly name everyone but I do want to shout out for a couple. My first assistant on the project was Ginny Pham-Kanter who helped get the blog a little more organized. But after Ginny had to retreat to graduate school, John Pluenneke took over. John’s been running the business and technical side of THCB since 2005 and this blog’s progress is more due to him than anyone else. Thanks, John!

These thank yous wouldn’t be complete without a thanks to everyone who’s ever written for THCB, or posted a comment. A blog is a microphone, but it’s only fun when that microphone is shared around. And finally, of course, thanks to you the readers.

The first few months there were only a few readers every week. When last month THCB had over 50,000 visits, those early days seem very distant. I’m really looking forward to the next five years!

But in the end, it’s all about one person sitting down and writing his or her thoughts and opinions — and hoping that somebody, who they probably have never met and probably never will, comes by to read them. On a personal note, thanks for reading mine. — Matthew Holt