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?