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Q&A: Local physician critical of Cook County health services

Sunday, November 18, 2007
Daily Southtown
by Emily Udell

Dr. Quentin Young began his long relationship with the Cook County Bureau of Health Services when he arrived as a resident at the county hospital in 1947.
After 60 years, he has become one of the bureau's loudest critics and most fervent champions as he spearheads a movement to convince the board to turn over administration of the cash-strapped bureau to an independent governing commission, a plan board president Todd Stroger said he would consider.
In addition to establishing a private practice, Young has worked at Oak Forest Hospital, served as chair of medicine for the county from 1972-81 and participated in a transition task force after Stroger assumed office this year.
Young, who calls himself a zealot, has been outspoken on health policy issues since he began his career. While attending medical school at Northwestern University, he crusaded to increase the number of women and minorities in medical training and improve access to medical care. In 1980, he founded the Health and Medicine Policy Research Group. He now also works with Physicians for a National Health Program, which advocates a single-payer health care system.
Q: Can you identify the beginning of Cook County's current financial crisis in providing health care?
A: The county became ... dependent on the funds that are available federally and matched by the state through Medicaid. It's a bit complicated, but what it does, in effect, is take the hundreds of millions that the county government dedicates to health care, and by letting the state receive (the money) before it's disbursed (to county), it has been eligible for match by the federal government. We literally doubled the actual dollars available through this (intergovernment transfer) mechanism.
Part of the crisis we're facing today is that the Bush administration has (scaled back) the amount available through this mechanism during a five-year period, with a decrease of literally hundreds of millions of dollars that was there before. That's the heart of the fiscal crisis.
One of the byproducts of this arrangement was that they developed next to no skills in collecting through proven payments submitted to agencies. There's no reason they shouldn't have recognized that through the declining awards through the (state-county transfer), they should rev up these systems.
Now, why they didn't ... there are many arguments there.
Q: And is this a change from what you saw when you were the chair of medicine?
A: My 10 years was under the governing commission, which was created by (then-board president Richard) Ogilvie, who went on to be governor. And he actually had in his platform to reform the county health system by creating an independent governance - the things we're talking about today. The independent governance was a mixed blessing, but I have to concede they were very skilled at collections.
When the governing commission was rescinded 10 years later, a new Republican governor, (James) Thompson, made a deal with his Democrat counterpart, (board president) George Dunne. He gave the whole thing back, and we went to the previous status quo.
Q: Why do people criticize that era?
A: They're disingenuous. I'm not uncritical of the commission. Among other things, they fired me twice, but I got restored by federal court.
I do not accept the criticism that is made by the incumbent county board that this was a failed experiment. They under-nourished it. No matter how good any managerial agency is, if you starve them enough, they will get dysfunctional. But they were never in their worst days ... as dysfunctional as they are now. We're looking at $300 million deficits. They never had anything like that.
Certainly there was still a political aura. You didn't constantly challenge the commissioners. But on the other hand, it was a little more kosher, more professional than it came to be under untrammeled county board leadership.
Q: Were the cuts made at the Oak Forest Hospital necessary? Was there a way to have avoided the discontinuation of the long-term care facility there?
A: The most harsh criticism I can make of this period of retrenchment is that they took a system of which Oak Forest was a very important part, and they disrupted it and made it a bunch of pieces that are uncoordinated and really dysfunctional because of infrastructural destruction.
Oak Forest was a huge tuberculosis sanatorium. With the subsidence of active TB and the need for these kinds of long-term care, Oak Forest was transformed into a very important rehab hospital for people with chronic illnesses. They developed second only to the Rehab Institute of Chicago, which is a world-class institution. When it came to budget-cutting time, Dr. Simon (interim chief of the health bureau) shut that down.
Q: So there could have been a way to save it.
A:I think they had several pathways when the reality of a huge deficit was on the table. That deficit didn't develop between '06 and '07. That deficit was embedded in the budgetary process for years, if not decades. What they did was conceal it. I think the concealment was bad government, bad management, and it's one of the many reasons I feel an independent governance that's transparent is very important if we're going to have a public system at all.
(If I were in charge) I would talk to the people who are hands-on in all of the ambulatory services and the in-patient services and get a consensus on what the workforce, which is after all, frontline, can recommend to cut. Any industry has excesses ... Beyond that, you would have to have policy decisions.
Q: Despite all these financial problems coming to the surface, what is county doing right?
A: I think the workforce has been so crippled that it's like a military unit that's taking huge casualties and trying to continue the mission. It's not possible. I think there are a lot of wonderful people still at county, but I hasten to add; a lot of wonderful people have left.
Q: What do you see as the future of the county health bureau?
A: In a kind of metaphorical way, about six weeks ago I said to anyone who would listen, there's a 100-to-1 chance this would turn out good, however defined. I think we're down to 10-to-1. The media has been very responsive, and the public, at long last, is learning there's more to county than corruption in the management. That there's a very huge public health responsibility, which will not be met in any other way.
That, broadly speaking, is the consensus of the private hospital community. A decade ago, the private hospitals endorsed the building of a new county hospital, rejecting the idea that was very popular in their circles: close the county, give us the money and we'll take care of it. They know the further deterioration of county threatens many of them.
This is the best script and it would resemble what was able to happen in Dallas. The county board would follow the advice of now four commissions and appoint an independent board. This board would be made up of people experienced in hospital management, in business management, funding and so on. And they, in turn, would have the responsibility of doing a search for a nationally recognized leader in health care. This person, if hired, would, in addition to all else, very quickly summarize what the short-term and long-term needs are to reconstitute the system. And in that environment of good faith, a social contract with citizens of this area, you would then legitimately get, in my view, the financial support you need.
I just think we need frank and total budget and then hopefully the citizenry, which is the ultimate arbiter, will support the reconstitution of this service.
I can't get this far in the discussion of what would happen without alluding to my favorite cure-all, and that, of course, is national health insurance. All this furor and all this disarray would go away, fiscally at least, if we had a national health insurance.
Q: You're saying there is possibility it's not too late?
A: I think there is a window of opportunity. It will be really rough, but I have to be optimistic, not ritualistic. I have a temperament about which more than one person says: "You're inappropriately optimistic."


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