RUTH ROTHSTEIN, Chicago's queen of public health, is disappointed.
Although she's proud of the clinical advances made in medicine during the past quarter century, Rothstein, a veteran of more than 40 years in the healthcare industry, says she thought that by now everyone would have health insurance.
"I thought we would have had a national healthcare program," says Rothstein, chief of the Cook County Bureau of Health Services, which runs Cook County Hospital, the mammoth inner-city hospital fictionalized on the TV drama "ER." The bureau also operates two other hospitals, prison health services, the county public health department and a network of 29 ambulatory clinics.
At 78, Rothstein is a notable figure in national healthcare circles. She was a board member of the American Hospital Association from 1995 to 1999.
In 1991, Rothstein took the top job as director of Cook County Hospital and then later that same year added the duties of head of the newly created health services bureau.
Rothstein, who relinquished the hospital post two years ago, still has a full plate. The bureau she oversees has an annual budget of more than $600 million and its facilities chalk up about 750,000 inpatient and outpatient visits annually. Of those, about 34% of the patients are uninsured or what is referred to as self-pay, a spokeswoman says.
"This is what I want to do. This is what I believe in," she says of the public health role.
For her part, Rothstein says she thought healthcare reform would have happened during the administration of former President Bill Clinton, but it went famously wrong. The problem, she says, was that Clinton's team, headed by then-first lady and now U.S. Sen. Hillary Rodham Clinton, didn't have the right people at the table, the people who knew grass-roots healthcare.
Not optimistic about reform
Unfortunately, Rothstein says she doesn't foresee another major government push to radically reform the healthcare system.
"If it's going to happen . . . it's going to probably happen incrementally," she says. But that's not a strategy she favors. "I'm not an incrementalist. I don't like it, but I'm a realist."
The national healthcare program she envisions would be like the one in Canada, where "everyone is taken care of," she says.
The next step in incremental reform, she says, should be providing healthcare coverage for the parents of children eligible for the State Children's Health Insurance Program.
She predicts that a catalyst for future healthcare reform could be the rising cost of prescription drugs. "I wouldn't have believed we would have allowed the pharmaceutical companies to get quite as greedy," she says. "The pressure has to be kept on the pharmaceutical houses."
Rothstein, who once worked as a union organizer, says she got into healthcare by accident in 1958, when she took a job as a laboratory technician at Chicago's Jackson Park Hospital and Medical Center. Rothstein moved up through the ranks at Jackson Park before going to Chicago's Mount Sinai Hospital Medical Center in 1966. There, she rose through a number of administrative jobs, eventually becoming the hospital's president and CEO in 1977, a post she held until the end of 1990 when she went to Cook County Hospital.
Rothstein, who doesn't have a college degree, says her work in public healthcare is the product of her upbringing during the Great Depression. "You start to take your sides and realize what side you're on," she says.
Like other healthcare leaders, Rothstein sees the enactment of Medicare and Medicaid in the mid-1960s as one of the defining moments in the history of healthcare, and the programs continue to dominate the industry.
"It gave institutions an opportunity to collect and have revenue, but it gave patients who were not insured . . . an insurance card," she says.
Although Rothstein is long past the age when many Americans retire, she says she has no plans to do so.
Among her achievements is presiding over the construction of a new $551 million Cook County Hospital. The 464-bed facility is expected to open for patients by August 2002.
"We've got to get the new hospital open first," she says of any plans to take a break.