First, stabilize the patient
Friday, October 26, 2007
Patronage and empire-building have so harmed Cook County's delivery of health care to poor citizens that it may take years to repair the damage. The decades of abuse and neglect trace straight to the offices of the County Board president and a generation of board members -- local pols who have no business managing an $800-million-a-year health system.
The Bureau of Health debacle is so severe that the most urgent question isn't how to fix it: First, someone needs to stabilize the patient. That means pushing aside the Cook County politicians and introducing new oversight.
County Commissioner Larry Suffredin, in league with an ad hoc coalition called the Emergency Network to Save Cook County Health Services, proposes an independent interim board of trustees. That would rescue management of the health system from county government's disastrous rule for at least three years.
The County Board would retain its taxing and funding role for the system. But the interim board and an outsider CEO recruited to run the system would take over its mission: ensuring primary and preventive care for indigent citizens. That would mean pushing the County Board, and Board President Todd Stroger's administration, out of the now-politicized functions of hiring, firing, awarding of contracts and financial operations. Local Democratic machine bosses would lose their grip on a health system with 7,000 jobs.
Suffredin will soon introduce an ordinance that would hand the dysfunctional Bureau of Health to an interim board. One purpose would be to rebuild public trust in a wasteful system, rife with political hires, that taxpayers now have no reason to view as competent.
Under former Board President John Stroger, Bureau of Health officials and board members knew the system was about to lose many millions in federal transfer payments. But they continued to pad staffing and spend at unsustainable levels, cynically figuring that county taxpayers someday would ride to the rescue.
Given Cook County's miserable financial stewardship of the Bureau of Health and the rest of county government, that infusion of tax money isn't likely. Taxpayers are furious.
Suffredin's proposed interim board would have nine members, most of them chosen by medical and public health groups. Who gets to do the choosing is of crucial importance: Cook County's idea of an "independent outsider" is someone who has fewer than five blood relatives on the payroll. The interim board would include two County Board members.
Hiring a CEO would be critical: Suffredin wants to recruit a pro who has managed big hospital systems and who would want to cap his or her career by salvaging a health system that once had a worldwide reputation for excellence.
A professional CEO, backed by an independent trusteeship, could force Cook County to revamp its health care priorities for the 21st Century. That should mean:
- De-emphasizing inpatient care, which has been in steep decline as Medicaid and Medicare patients increasingly choose other hospitals. The county's Stroger Hospital is roughly two-thirds filled; closing the under-used Provident and Oak Forest Hospitals would free up vast resources now devoted to empty beds.
- Expanding community care clinics. Decentralizing the system away from the underutilized hospitals would re-emphasize primary and preventive care: County patients could expect close-to-home care on par with what many of us receive from private physicians in their offices.
- Creating the modern planning function that the Bureau of Health now lacks. This means building a system to better measure such basic information as how many people of what demographics use which county services, and where. Tracking trends would let the bureau anticipate tomorrow's care needs today -- and deploy its resources accordingly.
- Demanding medical and financial accountability. Breast cancer screening, immunizations, prenatal care, diabetes and so on -- who's the one person answerable for each major area of care? The citizens of Cook County deserve to know how every area is performing: How many procedures a year? At what costs? What are the outcomes and follow-ups? What are the major problems that hinder better care?
In sum: A truly independent trusteeship, and an outsider CEO, could recommend the changes that would give more poor citizens better care, at a price county taxpayers can afford.
We support the trusteeship proposal for the Bureau of Health with one eye sharply focused on a similar arrangement this page also advocated: the installation of an independent outsider to run the county's shabby Juvenile Temporary Detention Center. The arrival of new management there should mean smarter use of existing resources.The stakes at the Bureau of Health are even higher. The Cook County Board slept through years when the county's health administrators sabotaged a once jewel-like system of care with rampant patronage, uncontrolled spending and failure to bill insurers for reimbursements. The clientele and the taxpaying public have paid steep prices for county politicians' lack of scrutiny.
Proposals to offload critical missions that county government has bungled have produced one comic effect. On Oct. 16 the Tribune quoted Commissioner Jerry Butler, a delightful gentleman, reacting to a blue ribbon panel's suggestion that county government relinquish control of its struggling health system, as it has with the county's juvenile detention center.
"If we're not going to do juvenile detention and now you're saying we're not going to do the hospitals, then what is the [Cook County] Board going to do?" Butler asked. "If they keep taking pieces out of the job, pretty soon you won't need commissioners either."
Hmm. We think Commissioner Butler said that as if it would be a problem.