Accountability
Forest Preserves
Public Safety
Cook County Budget
Forest Pres. Budget
Property Tax Appeal
Health & Hospitals
Policy Resolutions

Dr. Ramanathan Raju has been CEO of Cook County's health system for barely enough time to learn employees' names and figure out where his parking spot is. But he's going to need a steep learning curve.

His first order of business is critical: Stop the money hemorrhage in county health care.

Cook County President Toni Preckwinkle and health system officials are wrangling about how much county taxpayers will shell out to keep the system going in 2012. The health officials last month requested a $327 million subsidy; Preckwinkle made clear she won't tap taxpayers for that much.

Negotiators have found $110 million in savings and higher revenue estimates, and the subsidy request is down to $292 million for an $827 million budget. But Preckwinkle is holding firm. She doesn't want to provide more than $248 million in subsidy.

We like the direction this budget negotiation is heading, though we're skeptical about the prospective savings and the revenue estimates. Health officials promised much the same last year but didn't deliver. Result: A $96 million hole in the budget this year.

Raju needs to make sure that doesn't happen in 2012. County government faces an overall budget gap next year of $315 million. Preckwinkle rightly doesn't want to swoop to the aid of the hospital system with a big infusion of taxpayer dollars. There's no more money. "We feel that it's important for government bodies to take responsibility for their budget shortfalls," she says.

Dr. Raju: Believe her. She's pretty tough.

The latest quarterly report on county finances isn't encouraging when it comes to health care. It says the state hasn't sped up processing of new Medicaid applicants, so revenues that county health officials had anticipated aren't flowing in.

The report also notes that county officials haven't resolved long-running computer problems to ensure that patients are billed for care they receive at Cook County's hospitals and clinics. A system that can't bill patients and insurers can't survive.

Those are well-known problems that can be fixed.

Raju has an opportunity to start a discussion on an overarching health issue: County hospitals and clinics are seeing more patients who can't pay for care and fewer patients who can. Almost six in 10 people who show up in the county's hospitals and clinics can't pay for the services they receive, and there is no insurance or government program that will reimburse Cook County taxpayers for their care. Six in 10. As many as half of them are undocumented immigrants. A much smaller number live in neighboring counties and travel to Cook for treatment.

Cook County is eating those costs.

Can't those patients be treated before they show up at the emergency room, which is the most expensive treatment option? Can't city and county neighborhood clinics reach out to this patient population to draw them into cheaper, more efficient preventive care? Can't the surrounding counties be billed when Cook County provides for their residents?

Welcome, Dr. Raju. We hope you found your parking spot. We really hope you have some answers.