MoneyCare Starring Billy Beane

It looks like Michael Lewis may have his next besteller, a team of doctors take on the system by using a statistical approach to health care.

So what the hell am I talking about?

It seems Oakland A's GM Billy Beane is bored with baseball and Eric Chavez's aching back and decided to tackle the health care system. In this NY Times Op-Ed piece along with former presidential candiate John Kerry and former speaker of the House Newt Gingrich, they call for a plan to rely more on medical evidence rather than guts, instincts and experience to chart the medical course for a patient.

It is no surprise then that the United States spends more than twice as
much per capita on health care compared to almost every other country
in the world — and with worse health quality than most industrialized
nations. Health premiums for a family of four have nearly doubled since
2001. Starbucks pays more for health care than it does for coffee.
Nearly 100,000 Americans are killed every year by preventable medical
errors. We can do better if doctors have better access to concise,
evidence-based medical information.

I'm not really sure how anyone could disagree, except perhaps Dusty Baker. It would seem with the tools at hand (computers and the Internet), that a structured system where diagnoses and their prescriped treatments charted against their effectiveness would be a valuable tool for any doctor that is still coherent enough to power up a computer.

We can then have websites and forums like medicalprospectus.com, themedicaltimes.com, etc where a bunch of armchair doctors could argue from the safety of their own internet connection about the appropriate treatment for a patient.

"Hey, Dr. Jones,  what were you thinking prescriping strengthening exercises when a debridement is effective 50.9% of the time, compared to 49.8% for exercises. You're a loser. Go die."

(Dr. Hecht is going to nail me on that one...I'm sure)

It is an interesting article and certainly something, along with getting all medical records online, that should be pursued immediately in this country.

In the meantime, I have a few domain names to register. 

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Comments

That sounds very scary to me. VERY Nazi-like.

You will wind up with decisions to not treat people and let them die just because the numbers are bad.

Me no likey.

you're a fool...and you should read the article.

Evidence-based health care would not strip doctors of their decision-making authority nor replace their expertise. Instead, data and evidence
should complement a lifetime of experience, so that doctors can deliver
the best quality care at the lowest possible cost.

What's the medical equivalent of Chadball? Chadicine? Chadical?* Will Cesar Izturis still be prominently involved?

*Chadical is actually a pretty cool nickname for anyone named Chad. Feel free to use that one.

What's the medical equivalent of Chadball?

Death?

+1 Dave

I just made a Palin joke. You ignored me. We can't be friends anymore.

Dude, you are such a chick.

Is this a you bro-king up with me? Sheesh! High maintenance.

I enjoyed your Sarah Palin/BCB comment, but you'd really only get a big response out of me with a retarded baby joke (see below re: The Onion saying that it's hard to raise five retarded children).

Lets just hope doctors dont start prescribing Jeremy Brown medications. On a baseball note, Pat Listach is leaving the organization to become the Nats's 3rd base coach:

http://sports.espn.go.com/mlb/news/story?id=366214...

well that should move some folks up a rung...

Cory Bailey to AAA, Jody Davis to AA and Sandberg to Hi-A

although I guess I wouldn't be surprised to see Jody get the AAA job, seems to be held in high regard moreso than Sandberg.

Chadicaid.

Holy fuck. Anyone read bleedcubbieblue? It must be a joke, right?

http://www.bleedcubbieblue.com/2008/10/20/637547/b...

It's all kinds of retarded, but the centerpiece, for me, is this:
Derrek Lee for Matt Cain and Alex Hinshaw.
THEN! Matt Cain for Ricky Nolasco. WTF?

Then, of course, Aubrey Huff and Kevin Millar at 1B and Luke Scott in RF. This, clearly, is because the Cubs are going to buy out Fuku's contract and he'll return to Japan.

i replied:

"Just more evidence
on why this board is run by and supported by the dumbest people in all of sports."

I heard Sarah Palin runs BCB now.

But they look great!!

well gee golly.

The Onion has finally caught up to my humor on Sarah Palin:

Jeri Anderson,Clerk: "Oh, leave the poor woman alone. I'd like to see you try and raise five retarded children."

that's a new watermark for speculative retardation in action.

how many times he use the words "I" and "me" in that piece?

there's trade proposals in there that a video game trade AI wouldn't even let happen...

Plus, I think read a paragraph where he said or at least claimed to have inside knowledge about the Cubs looking at a certain player or about the Cubs buying out Fukkakedome -- am I right, or did my mind play tricks on me? All the gibberish on that site gives me the creeps.

I love how Ann Taylor advertises on that site.

Actually, it's Matt Cain and Felix Pie for Ricky Nolasco. I definitely don't understand that one. The whole post reads like a comment on MLB Trade Rumors .com.

you know I glanced over that a few days ago and remembered why I don't read other Cubs blogs, but somehow I had missed that Matt Cain was involved in it. I mean....wow.

About Al's post at BCB:

Based upon the comments from Lou Piniella and Jim Hendry following the Cubs organizational meetings this past week here in Mesa, the Cubs will try and add an "athletic" lefty bat or two to the lineup if they can. 

The Cubs right-handed heavy middle of the order did struggle against the D'backs and Dodgers right-handed starters and right-handed bullpen in the past two NLDS, so the 2009 Master Plan may indeed involve trying to exchange one of the Big Five right-handed bats (Soriano, Lee, Ramirez, Soto, and DeRosa) for a lefty bat or two.

Soriano is untradeable, and I can't see the Cubs trading Ramirez or Soto. DeRosa has tremendous value as a multi-positional guy with power, which leaves D-Lee as the most-likely candidate to get moved. 

D-Lee does have a "no trade," but the one place he would probably be willing to go is San Francisco, so that he could be closer to his family in Sacramento, especially his daughter. And I could see the Giants having interest in Lee, to give themselves another power bat in the middle of the order. But I cannot see the Giants trading Matt Cain to get him. No way.

Rather, if the Giants were to acquire Lee and the $26M that remains on his contract ($13M per year 2009-10), they would probably want the Cubs to either pay some of Lee's salary in 2009-10, or else take back players who are (combined) making what Lee makes, at least in 2009. If it's the latter, the most-obvious candidates for the Cubs to take back from SF to offset Lee's 2009 salary would be OF Randy Winn (who will make $8.25M in 2009) and LHP Noah Lowry (who makes $4.5M in 2009 with a $6.25M club option for 2010).

Winn is 35 years old, but he had one of his best MLB seasons in 2008 (306/363/426 overall, with a 313/371/410 split vs RHP, and 25 SB with only two CS). He is a switch-hitter who can play all three OF spots (although RF is his best position) and can hit anywhere 1-2-3, depending on the needs of the team. 

Lowry missed the 2008 season after undergoing forearm/elbow surgery, so he would be a crap shoot in 2009. But that description fits the profile of Rich Hill, too, with the big difference being Hill is out of minor league options, while Lowry gives his team some flexibility because he has two minor league options left.  

So I could see the Cubs trading D-Lee and R. Hill to SF for Winn and Lowry, and then signing or trading for a veteran left-handed hitting 1st baseman with power. Mark Teixeira would be ideal, but if they can't sign him, Aubrey Huff (48 doubles and 32 HR in 2008) would be one likely fall-back option.  

As for Kosuke Fukudome, the Cubs probably have had some internal discussions about how to jettison him if it becomes necesssary. Working out some kind of de facto "trade" with the Yomiuri Giants would probably be their best bet (Fukudome almost signed with the Yomiuri Giants a year ago before he decided to sign with the Cubs), but I doubt that it will happen this off-season, although I guess it could (especially if the Cubs acquire a RF). And if it does happen, the Cubs would almost certainly have to pay a substantial portion of Fukudome's remaining salary. 

"Not only has he been durable, he's been productive." "He can hit three, four or five in any lineup."

-Lou Piniella 2004

I love your quoting methodology. That's MLA, right?

"I love your quoting methodology. That's MLA, right?"

MLA? Why not APA? Shut up. Just shut up.

(Sick & tired of picayune citation style wars. Damn geeks.)

I would be ok with bringing Winn in to play CF though I'd rather the Giants keep Lowry and use the remaining $4-5 million between Winn and Lee's contracts to put towards Teixeira. No Huff, he's a DH.

So, does MoneyCare only work during healthy times and chokes in sickness?

I kid, I kid.

i can't wait until some obscure doctor is profiled as a demi-god in the new book.

i bet the profiled doctor spends his time doing freeweight lifts and screaming at his employees while performing surgery.

This topic is way more complex than a short answer can give, but one of the problems with "concise" evidence based medicine and outcome based "pay for performance" is how flawed is the data collection? It is in an early stage but those driving this probably they won't get it right. It's hard enough to have a good scientific study that truly proves one treatment over another. Particularly when the motivation of the study is to limit cost. When a truly valid study is done, doctors usually listen. Medication rxs change based on such studies, even surgery techniques change over time although technology improvements are frequently the drivers of surgical procedure improvements. There are just many variables which must be controlled to make things comparable. When the government starts/stops paying based on flawed information, it is mostly to avoid expenses but it usually just shifts payments to other pockets.

We can argue over baseball stats, argue over the intangible value of scrappiness, but even sabermetrics has a tough time measuring many things, ie. catcher defensive skills (CERA anyone?) and measuring medical outcomes is often much more subjective and the useful measurable stats are open for more debate than WARP, VORP or PECOTA.

My bias is the insurance management layers suck out absurd amounts of money from the system. Might be better if the insurance companies were mutualized so their insured got the profits returned to them.

The 100K deaths from medical errors stats need closer scrutiny including changing the malpractice climate but I doubt that those events would be significantly changed by evidence based algorithms. I suspect those events are more related to flat out mistakes/errors that should have been picked up on earlier, but not due to treatment off the mainstream path.

For examples:
That would be like telling ARam, Theriot, DeRosa and DLee that they shouldn't boot grounders in the same NLDS playoff game. Bad outcome, lets not pay for that kind of performance.

...or telling Dempster not to walk 7 batters in 5 innings work in game one of the NLDS. Bad outcome, lets not pay for that kind of performance.

...or telling Soriano his OBP isn't high enough and then getting him to not swing at pitches bouncing in the dirt when there are two outs in the last game of the NLDS. Bad outcome and Moneyball hasn't fixed Soriano, never will.

i have no idea how the economic-social aspect of "quality of care vs. what you can afford" comes into this book/study/etc.

while most all doctors spent a lot of time and money to learn their craft not all of them are skilled equally. to put it another way...you can be damn sure you got a better chance in a courtroom with your own hired lawyer who's good at a specific series of defense vs. a court appointed lawyer that happily works most of his cases through court appointment work. there's a reason those high-end hired guns cost so f'n much and naturally exclude a chunk of the population even if both guys are competent at what they do.

and beyond all that...and maybe more important...how does aftercare factor into it? that can be just as important as the actual procedure to "fix" the problem.

I think the key here, as I cited earlier, is to offer it as a tool for doctors, not replace them or force their hand.

Working closely with doctors, the federal government and the private
sector should create a new institute for evidence-based medicine. This
institute would conduct new studies and systematically review the
existing medical literature to help inform our nation’s over-stretched
medical providers. The government should also increase Medicare reimbursements and some liability protections for doctors who follow the recommended clinical best practices.

the last sentence is probably taking it a little too far, the first two though seem to be a tool that could be extremely valuable.

I do have a certain degree of knowledge on the subject of foreign health systems. I've been to doctors in seven countries (that I remember). I don't know about cost, but without a doubt, the best diagnosis I recieve is from US Doctors. In one case I reported the same symptoms to doctors in three countries, and the doctors perscribed the following:

Tea
Anti-biotic
Rest

The US doctor was the one who correctly diagnosed the illness, during about a 60 second conversation, which she then confirmed with a blood test.

There's myriad reasons that healthcare costs a lot in the US, and there are reasons that Americans aren't as rugged as other countries' citizens. If we weren't the most obese country in the world, a lot of these 'problems' would solve themselves.

Yeah, when you're crunching numbers on medicine you're dealing with such a wide range of doctors' abilities, know-how, knowledge of best current treatments etc. that what gets spit out at the end could be fairly problematic.

I know my Dad was told by a suburban doctor that he had six weeks to live. Two days later, after visiting a doctor at Loyola, he was in an operating room. That was over 25 years ago and he's alive today.

Half the doctors out there finished in the bottom half of their class.

"Half the doctors out there finished in the bottom half of their class"

Glib but probably not true.

Doubt that every person who graduates med school practices.

I was about to point that out.

That's true. But they aren't all from the bottom of their classes. I know two docs that aren't currently practicing and both finished near the top of their classes. I should have said - of those receiving degrees in medicine, half finished in the bottom half of their classes. Short of a census of every doctor in the country, whether more from the top or bottom go on to other things is anyone's guess.

My main point is - there's a lot of dumb asses practicing medicine out there.

SABERMEDICS

just replace CERA with CEBM

http://www.cebm.net/index.aspx?o=1116

color me not optimistic

and here is the Ortho Academy link (AAOS)

http://www.aaos.org/Research/Committee/Evidence/eb...

The AAOS is working on it.

Hendry's also working on it.

I don't see anything wrong with it per se. It's just another tool you can use, meaning that you can choose NOT to use it. So it's better to have it available than not. Most baseball scouts and the establishment were so against using stats and new metrics too for player evaluation, but it's here to stay whether they want to use it or not.

teams have been paying big money for custom stat evaluation long before the moneyball era. the idea that teams and scouts have no use for them or it's some new-fangled threat to their jobs as they know it is overblown.

it's importance in player evaluation has gotten larger and you now see stat guys on-staff rather than buying/contracting info out from a separate company.

...and plenty can be wrong with a stat in the wrong argument, imo.

http://www.desipio.com/?p=1755

Jeremy Hermida rumor...

Demp/Wood likely to be resigned

if they can trade Lee, it won't be to give Hoffpauir the job

Theriot probaby still starting (sigh)

nothing new but makes all kinds of sense....

http://www.bleedcubbieblue.com/2008/10/22/640524/b...

to echo most of that, Bruce Miles radio recap

although Bruce says the Cubs don't want to go a 3rd yr on Kerry and that's likely what he's looking for...

Yes Hendry got taken in Pierre trade, but he did alright getting Lee and Clement also.

So he's due, right?

Let me say right off the bat, I'm in no way affiliated with the website I'm about to mention, but if you like sports and making money do yourself a favor and check out OneSeason.com.

It's a stock market (using real money) that trades virtual shares of pro athletes. There's one Cub available right now (ticker symbol: BIGZ), and he gained 179% today.

If you're worried about it's legitimacy, don't take my word for it...

WSJ:
http://online.wsj.com/article/SB122471163578159995...

Time:
http://www.time.com/time/magazine/article/0,9171,1...

At least for the time being, every player listed just continues to go up. As more news outlets pick this up, more people are flooding the "market" with money. This may not be a good long term investment, but for right now it's pretty nice.

Paul Kinzer, the agent for Aram, Furcal, K-rod, Soto, and likely Marmol soon (according to Levine) was on Talking Baseball with Levine. Some intresting nuggets from it:

* Aram has won the NL Version of the Hank Aaron Award given to the best hitter in the league. The voters for it are the brodcasters for all the teams on both media formats (70% of the vote) and the fans (30%) according to Wikipedia. He will get it tommorrow before Game 4.

* He insisted that a deal for Furcal to the Cubs was really close 3 years ago, but the reason for no deal had more with contract language than money.

* He thinks the market for him will be 7 to 10 teams.

* He is still intrested in the Cubs. Levine said both Chicago will be looking at a MI who can lead-off)

* Kinser thinks he can get 15 mil a year for Krod.

I LOVE THE TRACKBACK.COM FEATURE.

IF YOU NEED A LOWERMORTGAGE.COM OR A BIGGERDICK.COM PLEASE CONTINUE THE FINE JOURNALISM.

WE HERE AT PIMPMYSITE.COM HAVE BEEN READERS FOR $UNKNOWN_VARIABLE YEARS!

WTF is trackback?

I have no idea, I just had to add it to do the archive import that never happened. Once I'm finished with that, i'll get rid of it hopefully.

i'm just playing around, fwiw.

trackback is another reason why no one on the internet "can have nice things." hehe...

in theory it's a great tool, but the abuse of trackback and minor importance of the feature in the first place makes it disposable.

http://www.thecubreporter.com/2008/09/27/cubs-rall...

awesome.

some trackback gems from those 11 trackbacks:

"Free sex animal.
from Gay animal sex. on Wed, 10/22/2008 - 5:49pm"

"Loans.
from Loans. on Sun, 10/19/2008 - 2:46pm"

"Big boobs alert.
from Big boobs. on Mon, 10/13/2008 - 5:47am"

Gay animal sex

What kind of weirdo is into GAY animal sex? Hetero animal sex on the other hand, who's not into that?

And I think you've got a typo there. I'm sure the trackback was for Big Bobos.

I'm gonna be honest here. From a distance, I can't really tell the difference. Sometimes I wonder if I only think I'm enjoying watching some wholesome hetero animal sex when really some male platypus is giving it to another dude platypus. And that causes queasy feelings that really hamper my concentration.

You haven't even begun to discuss species that can actually change their gender like amphibians. That gives new meaning to going both ways.

No good will come of this.

http://www.chicagotribune.com/sports/baseball/cubs...

According to Baseball America, the Cubs slipped from ninth to 15th in total budget for the amateur draft, spending about $600,000 less in 2008 than '07. The White Sox increased their spending but can't exactly brag about ranking 23rd. The top five spenders were the Royals, Red Sox, Rays, Pirates and Giants. … The Cubs are on the list of teams for which Jake Peavy will waive his no-trade clause. This doesn't look like a fit, but don't be surprised if Jim Hendry tries to put together a package that would include a swap of first basemen, Derrek Lee and Adrian Gonzalez, who is supposedly untouchable.

Hendry will then try and trade Aramis for Arod, Theriot for Hanley Ramirez and DeRosa for Chase Utley.

That's the way you spread rumors, getting in double and triple disclaimers.

I'll see your ridiculous Peavy-Gonzalez rumor and raise you a trade-Soriano-and-get-Manny rumor.

http://www.chicagotribune.com/sports/baseball/cubs...

But remember, the White Sox aren't a realistic fit because Manny's another "right-handed base clogger."

Phil Rogers laptop needs one of those breathalizer starters that DUI guys have on their cars.

His article today was one of the most stupid ones he has ever written.

Manny to White Sox?
Manny to Cubs? after saying a NL team would be a bad fit.

What a dumb fuck.

"Phil Rogers laptop needs one of those breathalizer starters that DUI guys have on their cars"

awesome. just awesome.

Agreed. Quote of the last week.

I am really shocked that our budget went down from the Draft when we drafted 19th in the first and second rounds instead of third. Stunned, actually.

Contains the dreaded "someone familiar with the process," but Macha and Randolph apparently now ahead of Brenly in the Crew's managerial considerations:

http://www.sportsnet.ca/thewire/baseball/2008/10/2...

So, they should be due for a championship in a year or two.

http://www.bizofbaseball.com/index.php?option=com_...

Cubs were 6th most efficient in the NL in using their dollars, 13th in baseball.

This statistical thing is a fairly standard item among health care geeks; it's covered in Crisis of Abundance by Arnold Kling, which goes into the idea in a lot of detail. It makes sense for a lot of the reasons Moneyball tools make sense in baseball, with one big difference: nobody sues Billy Beane because his manager didn't call for a bunt, and the guy on first base happens to get stranded at third - even though it was statistically the right call.

Trans here.

For those who might recall that I teach at a U somewhere in AR, and who are now reading early reports of a school shooting on a campus in AR, rest assured that I'm fine.

Still busy as all fuck, but lurking around here, and very much not shot to death on campus tonight.

(I only mention because I'm already getting inquiries. Good to know that there are people curious about whether or not I'm getting shot....)

Be good to each other,

T

Hadn't seen the news yet, but I would have. Thanks for letting us know. I would have worried.

really?

i thought you died like 6 months ago, not today.

hi.

Trans-

Glad to hear you are okay, when I went to look up more info on the shooting I found out that Carlos is doing fine also-

http://news.yahoo.com/s/ap/20081027/ap_on_re_la_am...

What the hell is happening to my home state?

Trans, you're failing at keeping things under control in my absence:

http://www.fitsnews.com/2008/10/27/arkansas-is-get...

Heh.  destruction follows in my wake....

Did anyone catch the ESPN 1000 radio broadcast of WS game #3 last night (Saturday night)? During the rain delay they played a tape of the 2003 NLCS game #6, otherwise known as the Bartman game. I was driving to a Halloween party and had to get out of the car in the 8th inning with a 2-2 count on Castillo. While I half didn't mind shutting off the radio at that point, it was interesting hearing the radio commentary about the Cubs and Prior at the time when they were still ahead 3-0 in the game and 3-2 in the series, especially knowing what we know now about both of them.

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