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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.
Comments
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
What's the medical equivalent of Chadball?
Death?
Re: MoneyCare Starring Billy Beane
+1 Dave
Re: MoneyCare Starring Billy Beane
I just made a Palin joke. You ignored me. We can't be friends anymore.
Re: MoneyCare Starring Billy Beane
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).
Re: MoneyCare Starring Billy Beane
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...
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
Chadicaid.
Looks Like Isiah Thomas may have tried to committ Chadacide
http://news.yahoo.com/s/ap/20081024/ap_on_sp_bk_ne...
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
i replied:
"Just more evidence
on why this board is run by and supported by the dumbest people in all of sports."
Re: MoneyCare Starring Billy Beane
I heard Sarah Palin runs BCB now.
Re: MoneyCare Starring Billy Beane
But they look great!!
Re: MoneyCare Starring Billy Beane
well gee golly.
Re: MoneyCare Starring Billy Beane
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."
Re: MoneyCare Starring Billy Beane
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...
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
I love how Ann Taylor advertises on that site.
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
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.
Re: Aubrey Huff
"Not only has he been durable, he's been productive." "He can hit three, four or five in any lineup."
-Lou Piniella 2004
Re: Aubrey Huff
I love your quoting methodology. That's MLA, right?
Re: Aubrey Huff
"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.)
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
So, does MoneyCare only work during healthy times and chokes in sickness?
I kid, I kid.
Re: MoneyCare Starring Billy Beane
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.
Re: MoneyCare Starring Billy Beane
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.
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