Most county governments have farmed out day-to-day operations of public health systems. But Cook County, Ill., which runs the third-largest such system in the country, is just now attempting the feat of using its political process to shed the taint of politics from the administration of healthcare for the poor in Chicago and its suburbs.
Of more than 100 public hospitals and systems in the country, No more than a dozen of them are organized and structured in what youd call the old-fashioned way, where theres no governing board or legal structure outside the county, said Larry Gage, president of the National Association of Public Hospitals and Health Systems. But the transition, Gage said, demands that somebody step forward and take a leadership role and be a force of reason.
The county health system, with three hospitals and a network of clinics, finished its fiscal 2007, ended Nov. 30, an estimated $69 million in the red, even though it started the year with massive budget cuts. An independent panel in October produced a report on the systems crisis that was dispassionate in tone but shocking in its conclusions: a complete lack of long-term financial or strategic planning; a failure to plan for the loss of federal intergovernmental transfer funding; and a chief with no real authority.
Also cited was a perception that the Cook County Board of Commissioners runs the health system based on politics rather than whats good for patients. Robert Simon, the interim chief of the county Bureau of Health Services, was brought on by county President Todd Stroger, who was elected in 2006 to replace his father, John Stroger Jr. Simon quickly made enemies when he closed clinics and laid off doctors and nurses to carry out an order to cut $100 million from the budget.
While Strogers political enemies consider Simon mired in what they believe to be a patronage mill, Simon calls the critical report outstanding and supports divorcing the health system from the county commissioners. Its an archaic, insane bureaucracy, and it has to be fixed, Simon said, noting that the board is responsible for every hire (a 21-step process, he says) and must approve expenditures beyond $25,000.
Stroger, a Democrat, has appointed Repub-lican county Commissioner Gregg Goslin as chairman of a task force intended to hash out a framework for independent governance of the system by mid-January, though a meeting last week showed two members oppose the idea. Goslin is recommending a seven-member volunteer board of healthcare and business veterans, appointed by the president and confirmed by the commissioners, and said the county should consider asking the Illinois General Assembly to give the new board taxing authority.
Goslin recently visited Parkland Hospital & Health System, Dallas, considered a model public system, and has sought the counsel of Ron Anderson, its president and chief executive officer, who said in an interview he can tell the Cook County leaders are struggling to let go. I see theyve done a lot of soul-searching here, but theres a lot of reports back to and opportunity for them to audit, Anderson said. Are they really saying theyre delegating the responsibility or halfway holding on?