For those not familiar with the movie, it's a true story of how a baseball agent/scout (played by Jon Hamm) travels to India and arranges a contest to find young Indian cricket players to come to the USA to play baseball.
During the course of the interview, Bill Simmons was noting Lake Bell's interesting career, where she initally had a traditional Hollywood actress pathway of some marginally-successful runs on TV shows and movies, despite being clearly immensely talented. She has found a new pathway to success, through things like the Emmy-winning web series "Children's Hospital."
Bill asked her at one point in the interview if Lake was interested in "getting on real TV." Lake gracefully laughed that she actually preferred being on "fake TV." This was a fascinating conversation for several reasons, which I'll highlight here:
1. Lake very appropriately realized that Hollywood was not savvy enough to take advantage of her talents, and she sensed a market inefficiency. In particular, she noted that only a small % of movies are directed by women, even though they do a high % of movie ticket purchases. FiveThirtyEight had an excellent blog post about this a few weeks ago, noting that this is a true inefficiency - Hollywood would do better financially if they took the women's view into mind more.
2. Lake had one area of particular passion, which was voice over work. She noted that there is an enormous bias that has men do the vast majority of voice over work, and she struggled to find such work as a woman. She took a brave and pro-active approach to correcting this- she made her own independent movie about a woman struggling to get voice over work, called "In a World" which parodies the ubiquitous movie trailers that begin with that phrase. Check out the very funny trailer here.
3. A super important point here- Lake is VERY successful. She is not on a network TV show, but she doesn't WANT to be on one. Instead, she's on an Emmy-winning web series, directing her own movie, about to come out in a big studio movie, recently married, and happy. She created her own pathway to success.
4. What's incredibly ironic is that this line of questioning is coming from Bill Simmons. For those not familiar with Bill Simmon's back story, he is often cited as the single most successful individual who has parlayed non-traditional media to create an empire. He started writing a small web column called "Boston Sports Guy" back in 1997, when there really wasn't such a thing as a web column. He created a great product, and eventually moved up the ranks through ESPN. He has been called the "Most Influential Man in Sports Media" by his competitors at Sports Illustrated, and ESPN made him the editor in chief of their influential Grantland website. In full disclosure, Grantland is my favorite website, and I'm a huge Bill Simmons fan.
So, what's incredibly ironic is that if there was one human being on the planet who should appreciate that success shouldn't be defined by having to participate in traditional products, it's Bill Simmons.
Yet, he fell into the trap of assuming that there is only one pathway to success.
Segueing .... in the excellent book The Long Tail, Chris Anderson notes that the trend in the current economy is to offer people choice. The long tail in the title refers to the shape of a Pareto distribution (see picture above). The concept in the book is that in the past, consumers had limited choice, and the bulk of sales occurred on the left side of the graph. For example, the vast majority of books sales were the top 20 best-sellers, the vast majority of record sales were on the Billboard Hot 100, etc.
For example, I grew up consuming traditional media. I read my local newspaper everyday (the Trenton Times), listened to Top 20 radio, and watched The Cosby Show and Facts of Life just like everyone else. It was ok.
Now, I consume media I really enjoy. I read my medical websites, but also enjoy Grantland, FiveThirtyEight, but also websites for my favorite niche sport, Mixed Martial Arts. I listen to lots and lots of Podcasts, which is my favorite form of media. And I hardly watch TV or listen to radio. It's a completely different way of consuming media, and I vastly prefer it. Choice is simply better.
This applies to all walks of life. I love Chipotle. That said, I am really glad that Baja Fresh and Qdoba exist. I love that we have a choice. Even if you go to Taco Bell, they've had to improve their game because of the competition created by Chipotle.
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So, what the heck does this have to do with healthcare? Well, in every other facet of life, the trend is to embrace the Long Tail, and offer consumers choice. But the trend in healthcare is in the OPPOSITE direction, to limit choice. This is not good, and as a consumer, this is not what you want.
One popular model is that idea of a "narrow network", where a large employer or insurer will contract with a limited group of providers, and the consumers will have to use the provider that is within that narrow network. This, in my opinion, is definitely not in the best interest of the consumer.
I'll give a very specific, real example of how this hurts patients. On Friday afternoons, I perform my spine procedures at the Overlake Surgery Center in Bellevue. When I perform procedures, in the operating suite next to me there is another physician who is also performing spine procedures.
He's a great guy and a great physician. He is so awesome, in fact, that I am going to advertise on his behalf on my blog- his name is Llewellyn Packia Raj, MD. While I suppose he is technically a competitor of mine, I don't view him that way. I view him as an amazing, compassionate physician, with great technical skill and wisdom. I sincerely want him to be successful. I'd gladly see him as a patient, and would send a loved one to see him.
It is my personal belief that for some patients, Lew will be a better choice, and for other patients, I will be a better choice. While I think we are both very good at what we do and have some overlaps in skills and personality, I don't think we are equivalent.
So the question is- who gets to make that choice? The consumer, or some central agency defining a narrow network?
To me, this is obvious. The consumer, in this case the patient, should make the choice. That should be their right, and helps lead to a better fit.
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For the final leg of this blog post, I'll comment on a time I deliberately chose to escape a narrow network, and how happy it made me. When I moved to Pittsburgh, I needed to establish a relationship with a new dentist. My dental health plan had a narrow network, so I was looking for a specific dentist within that network.
I happened to have a patient who was a brilliant periodontist, and he was someone I also related to on a personal level and trusted. I asked him who I should see, and he recommended a great general dentist named Rick Gottlieb.
Dr. Gottlieb was out of my network, but my friend said that Dr. Gottlieb was so good he'd be worth paying cash to see, and gave me some anecdotes on how this would save me money in the long run. This was a big leap of faith for me- I had never willingly paid cash for something for which I insurance, but I trusted his advice and saw Dr. Gottlieb.
I am so glad that I did! Rick was far and away the best dentist I had ever seen, and I consider him the best clinician I've ever been to. I found the experience exceedingly pleasant (..... how often to people say that about going to the dentist!), and I felt confident about my dental health. I thought it was the best run office I've ever been to, and I've used it as a model when I think about how Garrett and I should run our office at Lake Washington Sports & Spine.
In terms of cost- I think my friend was right. By helping educate me about my long term dental needs, and helping prevent expensive long term periodontal care and other advanced procedures, I am likely going to save thousands of dollars in the long term. Now, from an insurer's view, they may not care. They don't care about savings 15 year downstream, and they are willing to be penny wise, even if it's pound foolish.
But here is an even more important point that is lost in the cost-savings debate- I really like Rick as a person. That means something to me, and it has value. Rick and I were social acquaintances when I lived in Pittsburgh. I don't know that it quite reached the level of "friend", but it was meaningful to me, and I knew very clearly that he cared about me as a person and was rooting for my interest, beyond me merely being someone who provided him income.
And I think that this is something that is getting lost in medicine in all of the discussions of cost containment, narrow networks, meaningful use, and similar blather. Medicine, at it's core, should be about the relationship of the patient and their physician. Like all relationships in life, you can make a best guess, but ultimately finding the right match is a give and take process, but when you find that match, it's wonderful.
To that end, I encourage physicians to take a stand and fight for patient choice. There is some risk in that process- you will lose some patients. But I am ok with that- even more than that, I embrace it! If someone chooses to see a great physician like Lew Packia Raj instead of me, that is their right, and more importantly, that frees up my schedule to find a patient who is an even better match for me.
...... I can just see the movie trailer now - "In a world, where patients have a choice ....."
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