Where are the tribunes of the people in the health-care debate?

Every day, the debate over health-care reform grows hotter – but newspapers and their websites are doing little to shape the outcome. This is not just journalistic failure, but also abdication of public responsibility. For all their cost cutting, newspapers still have the editorial resources to take ownership of how big local issues are covered and addressed – and health care is, above all, local. As four doctors who are health-care-reform advocates wrote in a New York Times op-ed on Aug. 13:

“…all medicine is local. And until a community confronts what goes on in its own population — to the point of actually seeking the data and engaging those who can solve the problem — nothing will change.”

The doctors examined 306 “Hospital Referral Regions” – which cluster hospitals used by most residents in their metro areas – and found that 74 of them met the doctors’ criteria for “more effective, lower-cost care.” Rich documentation about wide disparities in costs in hospital referral regions can be easily accessed at the Dartmouth Atlas of Health Care. The data can be repurposed into charts and other easy-to-grasp visuals that pinpoint high costs at one or more hospitals and lower costs at other hospitals all within the same metro area. This should be the starting point for newspaper coverage helping people to locate one of the crucial drivers of runaway costs: the availability of doctor-owned care-referral centers.

But go to newspaper websites today, and you won’t find them helping their communities understand this economic calculus of health care. I recently browsed five sites in metro areas that have the highest cost care, and only one site – the Miami Herald — was even taking a stab at owning coverage of the issue.

What I found:

  • Miami: It ranks highest among major cities in health-care costs. The Miami Herald got on top of the story when it was first published in the New England Journal of Medicine last February, and it’s also done these subsequent related stories: here, here, here and – two weeks ago – here and here. But despite its considerable, cumulative coverage, the Herald doesn’t have a special section on health care with comparison charts that would help make sense of the barrage of data on health quality and costs.
  • Dallas: Its health-care costs are among the fastest-rising in the U.S. – three times as fast as San Diego’s, according to a New England Journal of Medicine analysis of regional data collected by the Dartmouth Atlas. The new head of the American Medical Association is J. James Rohack, a Texas cardiologist who is affiliated with Scott & White Memorial Hospital in Temple, whose spending per Medicare patient is as much as 40 percent lower than hospitals in Dallas. A June 21 feature in the Dallas News on Rohack touched on this disparity. But there was no sidebar or subsequent story (that I could find) probing why Rohack’s hospital does so much better on costs.
  • Columbus, Ohio: Hospital Medicare costs here are increasing at a rate well over the national average – 4.4 percent vs. 3.5 percent. The Columbus Dispatch has data banks on popular baby names and lottery sales, but nothing that I could find on hospital quality/costs.
  • Charlotte, NC: It’s the same story here on hospital Medicare costs – they’re increasing at a higher-than-average 4.7 percent rate. But I couldn’t find any news about this trend in the Charlotte Observer. The Observer has done admirable special reports, including on the plight of Carolina meat workers, but nothing on hospitals quality/costs.
  • East Long Island (Suffolk County): Per capita Medicare spending at hospitals here was $2,500 more than in metro San Francisco, adding $1 billion to the total cost of patient care from this New York suburb. I found nothing about this disparity in Newsday.

It bears repeating what the doctors wrote in their Aug. 13 New York Times op-ed:

“…all medicine is local. And until a community confronts what goes on in its own population — to the point of actually seeking the data and engaging those who can solve the problem — nothing will change.”

It’s not too late for newspapers to mobilize their websites to take the lead in putting democracy in action. They have the resources to do so, but do they have the cojones?

Who else can be the tribunes of the people at this historic moment?

LA Times redesign doesn’t quite click

The LA Times website used to remind me of an old-fashioned hardware store – things were plopped wherever there seemed to be space. That changed when Meredith Artley took over as editor of the site in early 2007. Under Artley, latimes.com quickly became a leader in design and in featuring content that celebrates the special qualities of its metro area. So why is the site’s new design, despite some welcome improvements, specked with so many user-unfriendly mistakes?

The gray (screened) type is gone, thank goodness, but it has been replaced by type that, because of the limited way it’s used, produces an even grayer look that extends to the entire layout:

LAT website front page

The new typeface is Georgia, a serif version of Verdana, which Microsoft commissioned early on for its online readability. Georgia, which was inspired by Times Roman, is fine, but not when, everywhere, it is uniformly presented in regular font.

Gutenberg would be proud,” the Times presumptuously brags about its new Web typeface choice. But even Gutenberg used boldface and other typographical devices of contrast in his Bible, the first example of printing with movable type.

To achieve its hyper-cleanness, the redesigned LAT site often eliminates information that would be an important cue to the browsing user. In this strip of three homepage promos (below), the browser is not told that authoritative Hollywood staff writer Claudia Eller was the author of the first promoted piece.

Feature promos

The second promo is for the popular Column One feature, but who’s to know?

High up on the page on Monday, Aug. 17, was this headline:

Alcoholics misread facial expressions, study shows

The linked piece would surely have gotten more hits if browsing users knew it was written by Melissa Healy, the Washington-based Health section writer who specializes in articles on human behavior.

The site’s feature on “our new look” says it “better showcases the world-class journalism our newsroom produces around the clock.”

I wonder if the un-showcased Eller and Healy would agree.

The site has redesigned ads, but it’s not a good idea to format editorial promos in the same size as ads and then juxtapose the two, like here:

Ad on top of Entertainment promo box

Navigation has definitely been improved through dynamic subsection tabbing that changes when the user’s cursor rolls over main headings like LOCAL, NATION, WORLD:

LAT news nav bar

The redesign has earned plaudits from commenting users (“magnificent change! much more readable, and elegant.” “Oooh! Nice, very nice,” “MUCH BETTER”) but there have been dissents too. Stephen wrote on Aug. 12:

“At first glance, i didn’t like it. maybe it will grow on me. maybe what’s ‘under the hood’ is impressive, but the previous design was much more elegant and sophisticated….”

“Our work is not done,” online managing editor Artley and LA Times editor Russ Stanton blog on the site.

Maybe that means they’ll revisit some of work they’ve already done.

A final suggestion: To help users wrap their heads around all the news the LA Times serves up, the site should hire what I would call a “Web maitre d’,” who would, each day, in a one-minute video, summarize what’s featured – from the biggest to the quirkiest stories. Talented would-be presenters – we’re talking LA here – would be lining up at the Times’ Spring Street entrance for auditions. The overview would be delivered with a soupçon of drollery (no Daily Show stuff) – just enough to encourage users to keep coming back for more.

Newspaper websites offer no cure on health-care reform

Helpless to stop their print world from being pulped, newspapers are blowing a golden opportunity to use the Web to recapture relevance and audience. The occasion is a story that affects every man, woman and child in America – health care and how to universalize quality without busting the entire U.S. economy.

News about health-care reform is, obviously, all over the media, including newspaper websites, 24/7, but too much of it has a Washington dateline when, in fact, the issue is basically local. People seek care where they live, not on either end of Pennsylvania Avenue NW or on K Street NW in Washington. Most of the $2.2 trillion-plus in health spending is rung up within mostly compact triangles of doctor offices, hospitals and outpatient centers in thousands of communities.

In June and July, when Congress was grappling with five reform bills at the committee level, attention had to be on what was happening in Washington. But with Congress going on summer recess, the focus is shiftingto kitchen tables and town halls all over America.

Newspapers, with their still formidable local resources, should own this story as the locus shifts to their backyards. At a time when 63 percent of Americans say the overall health care issue is “hard to understand,” newspapers could make their websites the authoritative place for people to go for the A-B-C’s – how they would be affected personally, not as part of a statistical mashup that may or may not be accurate. Newspaper sites could become not only locally tailored information centers, but also help influence how reform will be shaped when Congress returns from recess. After all, Congress is made up of lawmakers who depend on votes from people who live in thousands of communities, all of which are covered – at least in theory – by local newspaper websites. But papers aren’t planting their flag in their own territory.

Yes, newspaper sites do features about local individuals and families that can’t get care they need because they’re not insured or are under-insured, or who have gone bankrupt because of catastrophic illnesses. But these publish-and-run stories amount to scattered, quickly fading pixels that don’t let users see the whole picture.

To cover a story that has such major and pervasive effect on every household, and which will be around for months, if not years, to come, newspaper sites should have a strategically developed, attractively designed and well-promoted special section on health care – and the emphasis should be local, local and again local.

Every newspaper site, no matter how modest, could be health care central for its community. A starting point could be comparing the cost of care at local hospitals. There is a wealth of published local data that newspapers could access free. One major source is the Health Care Intensity Index, produced by the Dartmouth (University) Atlas of Health Care, which compares Medicare-related costs – 22 percent of all health-care costs – among local hospitals and against the national median.

The Dartmouth Atlas offers Excel versions of its data, which means a newspaper site editor can, with just a few minutes’ work, show how local hospitals’ costs compare with other hospitals’. Here’s a chart I quickly produced comparing a selection of hospitals in Houston – which is in the high-cost range nationally – with the low-cost Mayo Clinic’s St. Mary’s Hospital in Rochester, MN:


The obvious question is why does the Mayo Clinic – whose health-care quality is rated among the highest in the country – spend far less per patient than most hospitals in metro Houston?

Editors at any local newspaper site could do any comparison – within the metro area, statewide or nationally, all within minutes.

More spending on care, especially in the form of expensive testing and elective surgery, doesn’t produce better outcomes, data shows. It would take a bit of shoe-leather reporting, but newspapers could find out why costs vary so widely within their metro area. Instead of just being passive platforms for rants, newspaper sites could invite (or, if necessary, arm-twist), local doctors, hospitals and outpatient centers to participate in live forums where they would explain and justify the disparities and answer user questions. The sites would provide the same platform for local small businesses and labor unions, insurers whose plans cover local residents, advocacy groups and – especially important – local members of Congress. Of course, community residents – insured, under-insured and un-insured – would be able to tell their stories and ask questions about contradictory claims.

Multiply all this content generated from the more than 3,400 hospital service areas in the country, and you’d have a powerful, instructive mosaic of health care as it is delivered and priced. You’d also have, very likely, hundreds of thousands of opinions – leavened by now easily accessed, locally driven facts and figures – on how much reform Americans want.

No longer would there be a vacuum that is now filled by the demagogues and naysayers who often make things up and get away with it because there’s so much confusion about the issue.

You’d have more – much more – than another Internet “conversation.” You’d have grassroots America, with the assistance of local newspapers, helping to shape the legislation that will ultimately emerge from Congress probably by the end of the year. But newspapers have to use their still-considerable local resources to exploit the untapped potential of the Web to turn talk into action.

Newspapers’ print world will probably be a quaint media niche by the end of the next decade. What will happen to newspaper websites – will they fade into the empty quarter of cyberspace?