The Obamas and the Chicago Hospital Controversy

What it really says about health care

As excitement mounted for the Democratic convention at the end of last week, The Washington Post published one of those loaded connect the dot stories tracing the Obama campaign’s ties to the University of Chicago Medical Center, one of Chicago’s premier teaching hospitals. The Post reported that, with the help of Michelle Obama, its vice president of community and external relations (now on leave), the big, 600-bed hospital embarked on a project to move poor people out of the hospital’s emergency department and into care in the community.

Ms. Obama helped create the hospital’s Urban Health Initiative, which aimed to redirect non-critical emergency room visitors to neighborhood community clinics. That, in turn, would free up space for well-insured patients with more complicated medical cases, who might need some of the expensive services the hospital is known for, like organ transplants and cancer care. In other words, the Post said, the hospital wanted to keep those patients who could pay their bills and rid itself of those who couldn’t (and who arguably shouldn’t be seen in the ER anyway).

At the suggestion of Ms. Obama and others, the hospital hired the firm of David Axelrod, Obama’s chief strategist and Sunday morning stand-in, to sell the program. Axelrod’s firm suggested the standard PR techniques—focus groups, branding, targeting messages to specific constituencies, recruiting religious leaders to write opinion pieces. The Post revealed other ties between the hospital and the Obamas: Valerie Jarrett, the medical center’s chairwoman who travels with the candidate; hospital board member Kelly R. Welsh, a bank executive who gave the Obamas a $1.3 million home mortgage loan, and Eric Whitaker, the center’s executive vice president who now runs the Urban Health Initiative. What these ties will mean for a President Obama, the paper didn’t quite say.

The Republican attack machine hustled to forge a link between Obama’s public statements on health care reform and the Chicago dust-up. The McCain campaign held a conference call with reporters to denounce the Axelrod spin on the hospital’s community initiative. “At the same time in 2007 that this spin was being conducted, Barack Obama was campaigning and talking about expanding access to health care and bringing to more Americans, even as this medical center was using his strategist to cut off access for poor people in Chicago,” McCain adviser Douglas Holtz-Eakin told reporters.

NewsBusters, a project of the Media Research Center, the conservative press criticism operation that bills itself as “the leader in documenting, exposing, and neutralizing liberal media bias” also tried to fan the flames with a post urging the media to explore the Obama ties. NewsBusters opined: “This does seem to be an absurd hypocrisy that the media members should be all over, don’t you agree? Given Obama’s position on the poor and the uninsured, if this issue gets little or no additional coverage, one has to wonder why.”

I agree the media should be all over the issue—but not because of Obama’s hypocrisy. The scenario in Chicago is being played out in big cities all over the country. Hospitals are burnishing their images as high-tech, gleaming places for those with tickets to health care—i.e. insurance. They do that by moving facilities to the suburbs where insured folk live, competing for insurance-rich patients (and even creating unholy alliances with the news media to help them do so), and discouraging uninsured people of every color from coming to the emergency room. It costs money to a care for a poor person with no means to pay, and it’s no secret that hospitals would rather not spend that money.

Which brings up the second part of the story—the community clinics, some funded (albeit inadequately) by the federal government, where these people get care. It’s not surprising that docs on Chicago’s South Side have found care there inadequate. Clinics are stretched to capacity, and always need more doctors to meet the demand. They must scramble for money from foundations and private donors who are looking to fund new innovative programs, not basic medical care. When patients need surgery, they have to beg local hospitals for free operating time.

Forget David Axelrod. The real story here is how those candidate-touted market forces are actually causing hospitals to fight with each other for elite patients, while the clinics must compete with each other for the crumbs—the few dollars that community organizations, including hospitals, are willing to spend on care for the poor. The Washington Post began to explore some of this, noting that the University of Chicago Medical Center did lend part-time personnel to some clinics and gave $350,000 to another. While helpful, many clinic directors will say these are really bandages, and that more systemic change is needed. What are the candidates going to do about the widening divide between rich and poor in health care? That’s the story we’d like the media to investigate as we head toward November. It’s time for some hard questions, and the Chicago contretemps offers a good segue.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.