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  Cook County is the second most populous county in the nation. It is the 19th largest government in the U.S.

U.S., county must find solutions

Friday, June 15, 2007
Chicago Tribune
by Dick Durbin and Rahm Emanuel
Letter to the Editor

It's no secret that Cook County's public health system is in trouble. What isn't widely known is that the federal government came close to making things much worse.

Fiscal problems at the county level recently resulted in layoffs of doctors and nurses, the elimination of some health programs and the closing of medical facilities that serve tens of thousands of poor people and those without insurance. Not only will these cuts visit new hardships on those least able to afford them, but they also increase the burden on crowded emergency rooms where patients without recourse must go for care.

Meanwhile, the Bush administration proposed earlier this year to cut federal Medicaid funding for "safety-net providers" by almost $4 billion. Safety-net providers are public hospitals -- like Cook County's Stroger Hospital -- local health departments and other facilities that provide the uninsured and vulnerable populations with health services. In Illinois, that proposal would have cost $623 million. In Cook County, it would have cost up to $235 million -- an amount that might have pushed our precarious public health system over the edge.

Such cuts are not just ill-considered, they're cruel. In economic terms, such cuts are also short-sighted. They would actually drive up health-care costs for millions of insured patients by forcing them to compensate for the increased cost to hospitals for the burden of providing care for the uninsured.

Fortunately, we were able to include language in the recently passed emergency supplemental spending bill to block implementing these cuts for one year. But blocking these cuts offers our broken health-care system only a reprieve, not a cure. At the federal level, we need comprehensive health-care reform that provides access to health insurance for all who need it. We cannot survive economically when 47 million Americans lack any health-care coverage -- or when U.S. companies are saddled with health-care expenses that far exceed those of their global competitors. We are committed to ensuring that health-care services remain available for those who need them. Skyrocketing costs and growing numbers of uninsured make our current health-care system unsustainable.

But Cook County government must also do its part. The budgetary and management problems must be addressed and quickly solved. Taxpayers cannot be asked to continue to subsidize a county health-care system that fails to bill patients for millions of dollars in services that could be recovered or that protects layers of highly paid management jobs while cutting frontline workers. We were able to spare Cook County and our state from severe cuts in federal reimbursement this year. But without significant reform of county health care, federal support is at risk.

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