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It's like amateur night at the lunatic asylum. That's how Dr. Quentin Young, former medical director of Cook County Hospital and a nationally recognized leader in public health care, describes the folks handling the finances of the Cook County health care system.
While leaving nearly $200 million uncollected in Medicare and Medicaid funds, the county has hired a collection agency to "terrorize people living in poverty" who have been unable to pay their hospital bills, Young said.
Cook County's health care system, which serves about 1 million people, is facing a financial crisis, but elected leaders seem unable and unwilling to deal with the problem.
According to a new group organized to save the county system, which includes an organization represented by Young, there is a simple first step necessary to solve the problems, and it wouldn't cost a dime.
Cook County needs to form a board of trustees to oversee the system to assure taxpayers that it is being managed "competently, transparently and without political interference," Young said.
Surgically remove the health care system from the political system and don't ask for any more money until competent health care and financial professionals have a chance to make reforms.
The Emergency Network to Save Cook County Health Services, as the new coalition is called, includes doctors, nurses, health policy experts, community organizations, labor unions, consumer advocates and others.
All of them are concerned that if the county's health care system continues to collapse, those 1 million residents, many of them uninsured, will lose their access to medical care.
In addition, those people will begin pouring into private hospitals, overburdening a hospital system already straining to serve the needs of paying customers.
William McNary, co-director of Citizens Action-Illinois, one of the coalition members, said the county health care system is going to need more money, but "no one will give you a nickel if they see patronage."
McNary and Young believe immediate action is needed to save the system and restore public credibility in the process.
But the Cook County Board and its president, Todd Stroger, seem unwilling to take such action.
Stroger did organize a 10-member review committee composed primarily of medical professionals to assess the problems with the health care system.
But he did it in part because U.S. Sen. Richard Durbin (D-Ill.) informed him federal health care funds likely would not be distributed to Cook County until it proved it had taken steps to reform a system that had been a patronage haven.
The review committee - which included Dr. Larry Goodman, president and chief executive of Rush University Medical Center - reached many of the same conclusions as did the group that McNary and Young are involved in.
"Management reporting capabilities, such as monthly financial statements and revenue and expense benchmark data, as well as business practices typical of hospital and health systems do not exist at the Bureau (of Health Services) or are only now being developed," the committee's report states.
"The Review Committee strongly believes that the president and the county board will need to fundamentally change their governance and oversight processes if the issues facing the Bureau of Health Services are to be successfully addressed," it says.
Young stresses that the lack of quality medical care in Cook County for its poorest citizens has implications for people throughout the region.
Illnesses are spread that might otherwise be prevented with the use of vaccines.
He maintains that delays in diagnostic tests and mammograms at Stroger Hospital could cause people to die.
Unfortunately, I can't see Stroger or the county board reacting in a logical way to any of this.
It makes perfect sense for county officials to do everything they can to restore public confidence in the health system before asking for more money.
But that same logic would apply to every aspect of Cook County government.
Instead of assuring taxpayers that he's doing everything in his power to rid the county of corruption, waste, patronage and nepotism, Stroger has hired friends and relatives in key positions and now is proposing a cornucopia of tax increases to fund the government.
Why would anyone expect him to treat the Bureau of Health Services - the largest provider of health care to uninsured, underinsured and public aid patients in the state - any differently?
Yes, he's cut the health care budget by millions and, along with it, necessary services.
He's closed seven health clinics, eliminated 230 nursing positions and shut down 25 beds at Stroger Hospital.
I'm not sure those are the kinds of cuts taxpayers are looking for when they demand reform.
Ultimately, neither the county nor the state are going to be able to keep up with the increasing number of uninsured Americans.
National health insurance is the only answer.
Until then, it truly is amateur night in the lunatic asylum.