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
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
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
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
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
“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.
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.”