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Budget Woes Fray County’s Public Health System

Sunday, December 13, 2009
New York Times: Chicago News Cooperative
by Don Terry

As a rule, Sam Garcia, 51, is so busy struggling to get by that he does not have much time to follow the maneuverings of Illinois’s elected officials. Nearly a year ago, Mr. Garcia lost his job at a suburban sheet metal plant, his health insurance and a piece of his pride all on the same day.

But Todd H. Stroger, the president of the Cook County Board, got Mr. Garcia’s attention last week when he warned about the consequences of the board’s vote to roll back the county’s part of the sales tax to 1.25 percent from 1.75 percent on July 1. Mr. Stroger said the board’s action created a $75 million hole in the county health care budget, necessitating deep service cuts, hundreds of layoffs and posing a risk that county hospital patients might “needlessly die.”

“It scared me,” Mr. Garcia said on a recent Saturday night while he waited in the emergency room at John H. Stroger Hospital. The hospital is named after Todd Stroger’s father, who was county board president for 12 years, from 1994 to 2006, until he had a stroke. “Where else am I going to go when I get sick?”

A bright red rash ran from Mr. Garcia’s wrist to his elbow. “I break out when I’m under a lot of stress,” he said, rubbing his arm. “At least, I hope that’s what this is.”

He stood up, draped his coat over his left shoulder like a shield and warily approached the nurse’s station. “I’ve been waiting 10 hours,” he said to the nurse.

“Ten hours, that’s not too bad,” she replied, flashing a friendly smile. “The longest I’ve seen is 30 hours.”

Mr. Garcia dropped his head and returned to his seat in the waiting area with about two dozen other people.

“Next time,” the nurse suggested as he walked away, “pack a lunch.”

The $887 million budget for Cook County’s health care system is already set for 2010. The big question — and concern — is 2011. It is too early to tell if the doomsday predictions of Mr. Stroger are political gamesmanship or sober analysis, sincere or show.

Whether his forecast is valid, it is clear that the public health safety net is becoming increasingly tattered, not just in Cook County but also across the country. Public hospitals from New York to Los Angeles are being flooded with the uninsured and the underinsured as double-digit unemployment persists.

At Stroger — the heart of Cook County’s three-hospital and 16-clinic public health system — about 10,000 people visit the emergency room each month.

As the health care debate continues, one thing is certain: Mr. Stroger has staked his political future on being right. He pushed through last year’s sales tax increase of 1 percent knowing he risked the ire of consumers and merchants. The board’s rollback brought the tax rate down to 9.75 percent from 10.25 percent, the highest in the nation.

Mr. Stroger had beaten back three previous efforts to lower the rate before his defeat last week. Using Stroger Hospital as Exhibit A, he argued that the poor and the working class would suffer even more if budget cuts forced a sharp reduction in services and more layoffs.

Mr. Stroger’s critics do not buy his claims.

“It’s all make-believe,” said Larry Suffredin, a Cook County commissioner from Evanston. “The president is exaggerating the numbers. He’s just trying to scare people.”

Margie Schaps, executive director of the Health and Medicine Research Policy Group, a public health advocacy group, may not be scared, but she is nervous.

“A loss of $75 million will have a severe impact,” Ms. Schaps said. “We have a perfect storm brewing: increasing numbers of people who are uninsured and a system under severe stress. We can’t devastate the public system and not expect an impact on the public’s health.”

Many patients at Stroger are poor and uninsured, while others are like Patricia Tellez, 45, a stylishly dressed suburban real-estate agent trying desperately to keep her family from falling out of the middle class.

Mrs. Tellez, 45, said she had sold just one house in 2009. She and her husband have been without private health insurance for three years. Though they live two blocks from Hinsdale Hospital, when Mr. Tellez complained of a searing headache the couple drove more than 20 miles downtown to Stroger Hospital.

“We heard that Stroger was cheap and had a payment plan,” Mrs. Tellez said. “If we went to a private hospital, maybe they would take you faster, but just to go to the E.R. might cost thousands of dollars.”

In 2009, the county hospital system cut 900 positions. Another 450 will be eliminated in 2010. Most of these positions were already vacant, but 350 people still lost their jobs.

“There isn’t any fat,” said William Foley, who in the spring took over as chief executive of the Cook County Health and Hospitals System, which oversees the system’s day-to-day operations.

A round of cuts in 2007 was even deeper; a half-dozen clinics were closed, resulting in a 20 percent decrease in clinic visits.

The county hospital system has long been abused and misused by patronage-seeking politicians, said Dr. Quentin Young, president of Physicians for a National Health Program, a single-payer advocacy group, and a former chairman of the hospital.

“It’s been a pigsty for jobs and contracts for years,” Dr. Young said.

In recent months, the sprawling system of 7,000 employees seemed to be slowly turning a corner. Thanks to millions of dollars in federal stimulus money, better billing procedures and other efficiencies instituted by the new management team, the system reduced its share of county money by $74 million, from $382 million in 2009 to $308 million in 2010.

“But all of that is in jeopardy if we have to take another $75 million hit,” Mr. Foley said.

Mr. Suffredin, a county commissioner, said he was optimistic that the system’s progress would continue.

“We have 12 months to figure out a way to come up with the revenue,” he said.

Jerry Butler, the lone county commissioner on the public health care system’s board, is less hopeful.

“We can’t fix the system without the money,” said Mr. Butler, who voted with Mr. Stroger to preserve the tax increase. “How many more bodies do they expect us to cut before we cut to the marrow?”

The lack of bodies is one reason for Mr. Garcia’s long wait at the emergency room, which he shared with Emilio Santos, 45, his new “E.R. buddy.”

Mr. Santos had lost his shipping-room job of 20 years and his health insurance. When a chronically aching leg began turning blue, he headed to Stroger for the first time.

“I always had insurance before,” he said. “Lord forbid the politicians fall into our category someday — then they’ll wish they put that penny back. Not one, but two.”

A nurse, holding a clipboard, appeared at the front of the waiting room.

“Garcia,” she called in a loud voice.

“That’s me,” Mr. Garcia said, jumping up. He had been waiting nearly 11 hours.

He turned to Mr. Santos, whose wait was into its fourth hour and said, “Good luck.”



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