It’s fascinating when two of my passions collide in the opinion pages of the New York Times like they did over the last week. On Friday, October 24, some seriously strange bedfellows came together to write about, “How to Take American Health Care from Worst to First.” Strange enough that Newt Gingrich and John Kerry joined together, but
the lead author was Billy Beane, often thought to be the pioneer in the
trend toward data-driven major league baseball general managers.
I’ve been studying the health care system for nearly two decades,
but I’ve been studying sabermetrics (complex baseball statistics) since
a decade before that. So you’d think that their argument would resonate
with me and, to some extent, it does.
Their thesis is rational in many ways. Much of what is done in
health care has no evidence basis, and we end up spending a lot of
money on things that are unnecessary or even detrimental (or, at the
least, things for which we just don’t know). By developing a better
evidence base and encouraging more use of it, we could improve quality
and lower cost.
What’s lost in their argument is that health care is not a spectator sport. Now being
an intense fan
(or, to be honest) a rabid citizen of Red Sox Nation, I have at times
believed that the way I sit, the clothes I wear, or whether the sound
is muted has an impact on the quality of play delivered by my beloved
baseball team. But in my more considered moments of reflection, I
recognize that I’m neither responsible for the Sox triumphs in 2004 and
2007 or their failures (which I will not painfully reflect upon here).
But in health care the “players” who are unpaid have a bigger impact
on the outcome of the game (in this case, their health) than those who
get paid the big bucks. You can call them patients, consumers,
citizens, or people, but you can’t call them spectators, because their
choices, actions, and behaviors dramatically affect their health and
the costs associated with their illness and care.
In fact, the only thing that may have a bigger impact on an
individual’s health than his or her actions is the collective impact of
the community or society. I’m not talking here about rally caps and
deafening cheers but our environment, the food economy, advertising,
transportation options, etc.
Although I thought the NYT Letters to the Editor on the subject were interesting, I was disappointed that none of them focused on this
angle (although one did address societal ills). Instead, they addressed
the moral vs. business distinction, the greater complexity of health
care, universal health care, and medical education reform.
Billy Beane is absolutely right about sabermetrics, and I fully
agree with Gingrich and Kerry that substantially more needs to be
invested in comparative effectiveness research and provider
reimbursement reform is critically important. But that’s only going to
move us forward a little ways. If we want to dramatically improve US
health care, we need to focus much more attention on advancing
participatory medicine and all of the components involved in it.