The Democratic primary for Cook County Board President has focused mainly on a single topic: The sales tax increase championed by incumbent president Todd Stroger, and trashed by his opponents. Taxes may grab the headlines, but there’s another campaign issue that could have a more lasting impact on Cook County. That’s the future of the independent board that currently runs the county’s hospital system.

Board President Todd Stroger has never really embraced the idea of the independent health board. And he’s made fighting it a main theme of his re-election campaign.

STROGER: Good afternoon.

Earlier this fall, Stroger stood with union organizers in front of the hospital named after his father, longtime board president John Stroger, and criticized the health system for some layoffs.

STROGER: We cannot allow, and will not allow, the board to pay millions of dollars to outside consultants, have them come in and tell us, ‘No, no. You don’t need this. Downsize, be small, be like the private hospitals.’ We don’t want to be like the private hospitals. Our system is here to help people.
The details of these layoffs are more complicated than the politics of them. You see, Stroger has a role in passing the health system’s budget, but he doesn’t get to choose who gets laid off. It’s this awkward situation he’s found himself in since first agreeing to give up direct control of the health system.

Watchdogs had long complained it was bleeding money, packed with patronage and waste, and needed outside management. Such management is the norm for most other public hospital systems. Stroger sacrificed his control two years ago to win enough votes to pass the sales tax increase he says was needed to fund healthcare. He also signed off on the members that make up the health board, but now questions their loyalty to the patients.

STROGER: The problem I have with the independent health board is they are so independent, they don’t have a constituency. I mean, who is their boss?

In a recent interview in his office, Stroger answered his own question.

STROGER: The board is made up, at least partially, of people who work for other hospital systems. That is their constituents. I mean, they’re really looking out for that hospital.

A handful of the health board members do work for other hospitals in the area, including the University of Chicago Medical Center, Mercy Hospital and Rush University Medical Center. But there’s no conflict, says chairman Warren Batts.

BATTS: From my personal perspective, the various hospitals around Chicago have very much to lose if his board is not successful in improving the healthcare to the poor and uninsured of Cook County. I think it all works to their advantage if we succeed.

Batts adds that health board members abstain from voting on issues when there’s a potential conflict.

BATTS: This is something we’re all very sensitive to. We don’t want that to be a problem at all.

Batts touts a number of changes in the system under the health board’s control. He says there’s a top-flight management team in place, no more patronage jobs and says there’s been a lot of belt-tightening without disrupting services.

But services may end being slashed next year, according to the Stroger administration, because of lost revenue from an upcoming sales tax cut. That budget fight could be the last stand for the independent health board. The ordinance authorizing its creation expires in early 2011, when all power reverts back to Cook County commissioners and the president.

PRECKWINKLE: One of the first things I would do would be to work with county commissioners to make that a permanent arrangement.

Chicago Alderman Toni Preckwinkle, a challenger to Stroger in the February primary, says the independent health board is working, and should stay in place. That’s also the opinion of clerk of courts Dorothy Brown, another candidate.

Stroger himself says he wants to find a different way to organize the board that makes it more accountable. Health board accountability is also a concern to a fourth Democratic candidate, water reclamation chair Terry O’Brien.

O’BRIEN: They don’t have to report to anybody. They do their own thing, and then they submit their budget to the board for approval. I have some reservations with regards to that because sometimes independent boards turn into empires.

O’Brien says he wants to review the health board every three years to determine if it’s getting the job done. But panel chair Warren Batts says that just doesn’t give his board enough time.

BATTS: The system had maybe 130 years to get really messed up. Without some sense of permanence, it’s very hard to change organization, because you build into it the idea that ‘We’ll wait these guys out. We won’t change.’

Batts says what’s needed is almost a whole change of culture. And that, he says, is going to take a long time.