Moneymedicine

“It’s hard not to be romantic about baseball.” So goes a refrain uttered by Billy Beane in the movie, “Moneyball.” If you haven’t seen the movie it is based on the true story of William Lamar “Billy” Beane, the general manager of the Oakland Athletics. Billy, given his personal disappointments in how ineffective baseball scouts were in estimating the “value” of a player, turned to “data” to guide how and who should play. In short, in 2006 Billy took a $62 million team to the American League Championships the same year the New York Yankees spent $195 million for nothing. Spending more money in baseball doesn’t necessarily guarantee better outcomes. Sound familiar?

Here’s a dialogue from the movie. The two characters are Billy and a fictional character named Peter Brand. Peter in the movie is portrayed as the one who taught Billy how to apply economic principles in interpreting a player’s performance.

Billy Beane: It’s hard not to be romantic about baseball. This kind of thing, it’s fun for the fans. It sells tickets and hot dogs. Doesn’t mean anything.
Peter Brand: Billy, we just won twenty games in a row.
Billy Beane: And what’s the point?
Peter Brand: We just got the record.
Billy Beane: Man, I’ve been doing this for… listen, man. I’ve been in this game a long time. I’m not in it for a record, I’ll tell you that. I’m not in it for a ring. That’s when people get hurt. If we don’t win the last game of the Series, they’ll dismiss us.
Peter Brand: Billy…
Billy Beane: I know these guys. I know the way they think, and they will erase us. And everything we’ve done here, none of it’ll matter. Any other team wins the World Series, good for them. They’re drinking champagne, they get a ring. But if we win, on our budget, with this team… we’ll have changed the game. And that’s what I want. I want it to mean something.

In real life the person who best fits the character of Peter Brand is Paul DePodesta and in truth the 20 consecutive game wins was in 2002 and the ALS Division Championship was in 2006 and its more likely that in reality Billy and Paul DePodesta were less concerned about “changing the game” than simply fielding a decent team after the Athletic’s owners slashed the budget in 1995. Facts can really foul up a romantic tale.

For a moment, however, consider the analogs to medicine. Over the years, U.S. medicine has been flush with money. The “value” of a physician was estimated on metrics that had little to do with bringing patient value to a hospital or more importantly a community. To medicine’s shame, baseball has vastly more “stats” on their players and these “stats” actually mean something insofar as how players are used across a team or teams. Ask a surgeon what are their reoperation rates or their rates of transfusion or average length of stay…silence. To be fair these are difficult numbers. Many point out that numeracy is so poor among patients that they wouldn’t understand these numbers anyway. But lots of folks can understand a batting average or a pitchers ERA. Medicine should and can do better.

It’s hard not to be romantic about baseball. I love baseball. There is some palpable sense that when sitting across from third base that the differences between rich and poor, black and white, young and old, times good and bad are all narrowed. The world seems a better place when considered across the bright green of a manicured baseball field. Medicine can be romantic too. All our differences should be no less narrowed and while the Listerine floors of a ward pale in comparison to a baseball diamond, the sick should sense the same opportunity for betterment in this “house.” Billy Beane turned down an offer from the Boston Red Sox to be their general manager at a salary that would have made him among the highest paid GMs in history. That sort of decision has to come from some deep place that values something more than money. Mission balances margin and margin is not the mission. Do you want to change the “game” of medicine? I do.

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2 thoughts on “Moneymedicine

    • There is no doubt that no amount of metrics will overcome bad ethics. The motivation behind any metric in medicine has to be to render better patient care and better patient and societal value. That ethic has too often been lost. Physicians have not been discerning enough in rebuffing industry or other drivers of therapies that are not patient centric.

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