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 today’s 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.

This entry was posted on Wednesday, October 29th, 2008 at 10:34 am and is filed under Data, Engaging Consumers, Inside the Beltway. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.