Thursday, October 25, 2012
Chicago Tribune

One of the highlights of the budget presentation Cook County Board President Toni Preckwinkle made last week to the Tribune editorial board was an impressively streamlined $868 million spending plan for the health system. In this case, what we didn't hear from Preckwinkle and health system CEO Dr. Ram Raju was even more impressive.

What we didn't hear were excuses for why the health care budget would gobble an ever greater share of taxpayer dollars. Instead, the taxpayer subsidy for the hospital system in this year's proposed $2.95 billion county budget is $254 million, the same as last year. The subsidy is down35 percent from 2010.

Nor did we hear excuse after excuse for why doctors couldn't bill patients, or why computer systems weren't talking to each other, leading to massive inefficiency and a bleeding bottom line that year after year tips the entire county budget into the red.

What we did hear is extremely encouraging: The health system's revenue shortfall will be vastly diminished — from $169 million last year to about $60 million by the end of this fiscal year. And 2013 should be even better, if the federal government comes through as expected — as it should — with a waiver allowing the county to gain reimbursement for Medicaid patients already being treated in the system. That would be a $197 million booster shot for the system.

These numbers are reassuring, not only to county taxpayers but to patients who depend on the system.

Let's remember, not too many years ago, there was no assurance that county leaders could keep this system afloat. Costs were rocketing out of control. County pols insisted that Oak Forest Hospital and Provident Hospital couldn't be downsized even as patient loads dwindled and entire wings emptied out.

The pols defended the inpatient-heavy edifice not because it delivered care efficiently, but because that's where the patronage jobs were.

In their private moments, though, the wiser county board members acknowledged that the system was financially unsustainable.

Then, in 2007, a jolt to the system: A Cook County state's attorney's legal opinion told county board members something most didn't know: They had no legal obligation to maintain the county's huge and underutilized hospital infrastructure to provide care to the poor. In essence, the opinion said, Cook County government operates its hospitals and clinics out of the goodness of its taxpayers' hearts. "Illinois law does give Cook County the power, but not the obligation, to maintain a county hospital," the opinion said.

No, most county board members didn't seriously consider ending the county's health care mission. But that letter did turn a spotlight on the county's rampant mismanagement of the system.

Doctors weren't regularly billing patients, assuming they couldn't pay. How many undocumented immigrants or people from other counties came to the Cook County health care system for taxpayer-subsidized free care? County health care officials didn't know. The abuses of the system were legendary: The county mailed prescription drugs to people outside the county and allowed "off the books" surgeries for health staffers' families, Cook County Board member Larry Suffredin tells us.

A 2006 Northwestern University report concluded what was obvious to all: Political patronage was crippling public health care in Cook County. Good doctors were kept from doing their best work because of incompetence at the top of the system. And the Cook County commissioners who oversee the system had no clue about how to fix it.

In 2008, Suffredin cut a deal: He supported a county sales tax hike in exchange for then-Board President Todd Stroger's promise to relinquish control of the county's health system to an independent board. We were highly skeptical that Stroger would follow through. But he did.

Four years later, Preckwinkle has kept her promise to roll back that tax. And the independent board, thanks to smart moves and savvy hires by former board chief Warren Batts and current leader David Carvalho, is leading a health care system revival.

Doctors are billing patients. The system is moving to a more efficient model at all levels, from procurement of supplies to delivery of preventive care and advanced treatments. Oak Forest has been converted into a regional outpatient center to better serve patients.

A decade ago, Cook County pols ran the health care system as a fiefdom of corruption and cronyism. Health care delivery finished a distant second to doling out jobs or contracts to friends and political allies.

Today, this system is on the mend.

That's good news for Cook County's taxpayers and for all the people who depend on this system to deliver quality care.