Editorial: Docs say more cuts bad for county health care

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Updated: November 18, 2011 8:39AM

Governments at all levels are slashing budgets, eliciting cries of pain and sky-is-falling warnings that the neediest among us will suffer — some exaggerated, some justified.

Against that backdrop, we listened carefully when four veteran doctors from Cook County’s public health system came to see us recently warning of dire consequences if the health system’s subsidy from the Cook Country Board were substantially reduced.

“To us, cutting the budget when we can’t even meet the need now is ludicrous. . . . We work at maximum capacity all the time,” explained Dr. Shari Schabowski, an emergency room doctor at Stroger Hospital. “Our system is saturated with super-sick people, so regular medical care doesn’t happen.”

This comes from doctors on the front line, top professionals who could work elsewhere but have chosen to work with, and now advocate for, patients who have nowhere else to turn.

They make a compelling case — but so does Cook County Board President Toni Preckwinkle, who is finalizing a 2012 budget that is roughly $315 million in the red. As she should, Preckwinkle is pushing every county-funded agency to do more with less.

As of Friday, a $44 million gap separated what Preckwinkle says the county can afford and what the Cook County Health & Hospitals System board says it needs to avoid cutting services.

Preckwinkle thinks the difference should be made up through more efficiencies, savings and more outside revenue. She is opposed to reducing services and thinks that can be avoided. Dr. Ramanathan Raju, the health systems’ new CEO, who started on Oct. 3 after helping to reduce a major deficit in New York City’s public health system, tells us he supports Preckwinkle’s approach.

For several months, Preckwinkle’s staff has been working closely with the hospital system to help it save money. Together, they’ve whittled down a gap that began at $125 million by reducing contracting and legal costs, tightening up purchasing guidelines, slowing hiring growth and reducing prescription costs, among other things.

This is the blessing of a budget deficit. Under the right leadership, such as that of Preckwinkle and the independent board that runs the health system, governments are forced to stop their maddening practice of wasting money.

But at some point, the cutting can go too far. And that’s where the doctors and the health system board think they are headed.

The independent health board has made great strides in reining in a bloated system since taking over three years ago. But their work has only begun, and without the crutch provided by the county through taxpayer dollars, the health system’s doctors, its board and its chief financial officer are convinced the $44 million gap cannot be bridged without cuts to core medical services.

“We’ve done a lot of belt-tightening . . . but at some point you come up against the health of the organization,” said Dr. David Goldberg, president of the Stroger Hospital Executive Medical Staff.

Preckwinkle’s staff told us repeatedly they think the gap can be made up through measures such as lowering costs for facilities, prescriptions, security and contracts.

The folks closest to the patients, however, don’t believe it can be done. Those are voices we must continue to heed.