Imagine a professional football team whose players don't know game scores or their own statistics. They don't see game films, and certainly never review them with coaches to analyze what worked and what didn't work.

Imagine also that they don't know the average statistics for their league, so even if they had their own statistics, they wouldn't know if those were good results or bad results.

They have no way to measure their own performance. They don't know if they are getting better as football players, getting worse, or staying the same.

Imagine further that coaches say that they don't give players a lot of information because it would just upset or confuse them if they had it. They say that only coaches have the specialized training that allows them to interpret the statistics.

The coaches also don't track whether the plays they call work or not. They just keep calling plays because those are the plays they've always called. In some cases, they call plays because somebody told them about a nifty new play to use -- even though the person telling them that wasn't able to say whether the play ever actually works or not.

Imagine that a lot of their coaching consists of telling players, "You need to do a better job playing football."

What do you think their chances would be of getting to the Super Bowl?

You probably wouldn't want to bet on that.

Now imagine a health care system in which patients aren't given their medical test results and have trouble getting their own medical records. They don't have a debriefing after treatment to discuss whether it improved their lives or not.

Even if they do sometimes get their test results, these tend to be postcards that say, "Your test was fine." They often don't get the actual numbers so that they could see for themselves if they are improving or getting worse.

Imagine further that doctors say that they don't give patients a lot of information because it would just upset or confuse them if they had it. They say that only doctors have the specialized training needed to interpret the statistics.

The doctors also don't track whether the treatments they prescribe improve people's lives or not. They often prescribe treatments because that's what they were taught, without having a clear picture of their benefits and risks. Sometimes they order a treatment because they were sold on its benefits by someone with a vested interest in selling the treatment and little or no information about its success rate in real life.

Imagine that a lot of their advice consists of telling patients, "You need to do a better job taking care of yourself."

What do you think the chances would be of getting great results from a health care system like that?

You probably wouldn't want to bet on that either. Yet research shows that that's the health care system most people experience today in America.

What would happen if John Madden were in charge of health care?

John Madden, in his sportscasting, treated football fans as if they were intelligent, thinking people interested in knowing the real story about what was happening in the game. And that's just how he viewed the spectators, never mind the people actually playing the game.

The health care system often makes the opposite assumption about patients. It acts as if patients would not be able to understand key facts about their own situations and that there's no reason to tell them. For example, one study showed that almost half the time, people being discharged from the hospital didn't even know what the doctors concluded was wrong with them. They weren't told.

And studies repeatedly show that doctors typically don't provide test results and prefer not to let you see what's in your medical records, on the theory that it would just distress you to have that information.

If John Madden were running health care, it's not hard to imagine that picture changing. For example, when patients had a serious disease, the doctor would provide -- and discuss with them -- a chart that compared the different choices for treatment. For example, perhaps a knee problem can be treated with physical therapy, with drugs, or with surgery.

For each option, the chart would explain how success is defined and the odds of achieving it. It would describe what patients like most about the treatment and what they like least. For example, patients might like drug treatment because it doesn't require taking time off work, as surgery does. But perhaps surgery, if it works, does a better job of eliminating pain. And so forth.

John Madden was famous for drawing diagrams to help explain key points to his audience. It was clear that he cared deeply about drawing fans in, sharing his expertise, and helping his audience understand the game.

Health care would benefit from a similar passion, broadly applied.