Baltimore may be the home to some of the country's finest hospitals, but the rate at which they are providing routine medical care that could (and should) be treated in a doctor's office or clinic shows "a fundamental failure" of the city's health system. That blunt assessment, in the Baltimore Sun, comes from the city's health commissioner himself, Dr. Joshua Sharfstein.

Data from a RAND Corp. study shows Baltimore residents are being hospitalized or treated in emergency rooms for conditions like asthma and high blood pressure at rates that are roughly twice those in surrounding counties and statewide. Nearby Washington, D.C., which has a similar proportion of uninsured, low-income residents, has lower rates. (Baltimore: 42 avoidable hospitalizations per 1000 residents, Washington 28 per 1000)

Sharfstein says the problem stems from clinics that are stretched to capacity and a shortage of primary care doctors who serve poor people.

"Our city's hospitals are the envy of the world," Sharfstein said. "But in the shadow of the hospitals, the clinics are overburdened. It's not one or the other, it's got to be both. We want the best hospital in the world, but we also want a better primary care."

More than 800 children were hospitalized last year for asthma attacks, nearly 1,000 people ages 40 to 64 were admitted for diabetes, and roughly 1,900 people 65 and older were hospitalized with dehydration, the newspaper reported. That's people (including children) who are getting sicker than they need to be, and costing more than they have to cost. So add Baltimore to the list of reasons we need health reform.