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The cure

Friday, October 23, 2009
Chicago Tribune
by Chicago Tribune editorial staff

Let's see, the pols or the pros. Which group can best cure Cook County's health care system?

For decades voters have trusted Democratic politicians who dominate the Cook County Board to do the job. In return we got a health system run as a patronage paradise -- a system so larded with inefficiencies and pure bloat that it didn't even try to collect reimbursements for the medical care it provided. Why bother? There was always more taxpayer money available.

More than a year ago, though, a new panel of health professionals took control of the system. Lo and behold, the pros are doing what the pols never would: They're cutting the featherbedded payroll -- and they're asking taxpayers for less money.

This naturally perturbs Todd Stroger, president of the County Board and loyal guardian of a notorious Friends and Family Hiring Plan that tells you all you need to know about his attitude toward patronage.

And the health system itself? With the pols largely pushed aside, the patient has a pulse. The new managers are focusing on providing better patient care: They're not asking a health system to prop up a political system stuffed with Democratic loyalists.

You could see signs of success in the $3 billion county budget for 2010 that Stroger proposed Thursday. The health panel plans a spending increase of $37 million for its portion of that total -- but is asking for $73 million less in subsidies from county government. Translation: We finally have a health management team that says it will provide better care and rely less on county taxpayers. The system's proposed budget of some $887 million for 2010 asks for 19 percent less from county taxpayers, without service cuts.

There are several reasons, but most boil down to this: efficiency. The county is keeping better track of patient bills, collecting about $37 million more so far this year than the $195 million it collected during the same period last year. That better collection system (including signing people up who are eligible for federal help) is also paying off in millions more in federal money for hospitals that treat low-income patients.

We finally have managers who are making a serious effort at cutting the bloated staffing. They're on track to make a net cut of about 950 jobs by the end of 2010 to save more than $60 million a year. Many of those "jobs" are empty positions that Cook County historically has manipulated for arcane patronage purposes. There's still a long way to go in right-sizing this system. Last year, the panel calculated Cook County could cut one-third of its employees and still rank near the upper end of the staffing spectrum compared to similar hospital systems.

We're finally seeing coherent suggestions for consolidating inpatient care at one locale, Stroger Hospital. Under a plan developed by consultants, Provident and Oak Forest hospitals would be downshifted to regional "hub" hospitals, providing outpatient surgery and other specialized services. That's not a service cut, as some critics will try to portray it. Poor patients will still get taxpayer-provided care, either at Stroger, at private hospitals or at local clinics. That consolidation should be fast-tracked through the panel and County Board: Cook County doesn't need and cannot afford three public hospitals, none of which is fully utilized.

Concentrating inpatient services is long overdue. At Oak Forest, health panel chief Warren Batts tells us, there are more food service workers (over 100) than inpatients (about 60). Oh, and there's no cafeteria. "You do have to scratch your head and you have to say what in the hell are they doing," Batts says. Provident, too, remains prepared for an inpatient load that just doesn't exist.

Want to know if these proposed changes are real or just posturing by a new health panel trying to look busy? Here's how to tell: Watch Stroger. Yes, the same Stroger who tried to stack the health panel with reliable cronies last year. Now he's fuming over the nerve of this independent board to be ... independent. Example: On Wednesday, health officials announced layoffs of 335 employees and elimination of hundreds of unfilled positions. Within hours, Stroger condemned the cuts, saying they "threatened core services for the uninsured, underinsured and unemployed . . . "

How would he know? Remember, Stroger has relinquished control of a system that he and generations of county pols had run into the ground. He turned it over to the health professionals on the panel. They're making smart decisions. Stroger needs to stay out of their way.

When health system CEO William Foley failed to tell Stroger about a plan to speed up pediatric emergency care a while back, Stroger snapped: "I think that we may have to remind you that we exist, Mr. Foley."

Keep this in mind: The independent health panel sunsets in 2011, unless it is extended by the Cook County Board. The panel should be made permanent now. That is how county taxpayers can remind Stroger that they exist -- and that they applaud the health panel for doing what's best for patients, not for Democratic politicians.


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