Why I Wrote "County: Life, Death and Politics at Chicago’s Public Hospital"

Many people have asked me why I wrote  “County.”  I wrote “County” (a memoir, social history of Cook County Hospital and a reflection on race, poverty and health care in America) because I am shocked by the gaps in health care that have only worsened in the past thirty years in the US.  I wrote “County” because what keeps me up at night is the fact that African-American men on the south side of Chicago (it’s only slightly better in Detroit and Harlem) will die eight years earlier than a white man.  And half of the premature deaths in these men are from heart disease and cancer- preventable and treatable. I wrote “County” because I am pained that African-American women in that city have twice the death rate from breast cancer than white women and it does not have to be.  I wrote “County” because when one examines the problem of racial health disparity in America the chronic underfunding and lack of coordination of the public hospital and private safety net sector in the US is a clear contributing factor.  I wrote “County” to make the case for a fair health care system, one that does not discriminate by race, ethnicity, insurance status or residence.

I went to Cook County Hospital as a 25 year old doctor-in-training to fight for the life and the rebuilding of this iconic public institution.  It was a fight that brought young doctors and nurses head to head with a corrupt political establishment that would have preferred to have County close or remain in chronic dysfunction.  In the course of this struggle we not only got a new hospital rebuilt, but developed a network of community health centers and innovative public health and treatment programs that became national models for the respectful delivery of care to the underserved. But it was not enough.

Despite these achievements, the chronic underfunding of our nation’s public hospitals and other safety net providers leave many out with disastrous health consequences.  It’s just that the demand for services outstrips the capacity. I have come to believe that a system of care that sends the poor and uninsured to one set of institutions and the wealthy and insured to another is unfair, likely to provide unequal results  and a contributing factor in the premature  deaths our nation’s uninsured experience.  Only a payment system such as “Medicare-for-all” that allows all US residents freedom to choose public or private institutions to receive their care has the chance to lessen the gaps between the insured and uninsured, rich and poor, white and non-whites.

“County”  tells the story of young doctors like me who decided  to take a stand for health equity by coming to this renowned public hospital and who stayed on to continue the fight for fairness that should have been available to patients as a simple condition of their humanity.  I tell the story through my experiences, through the stories of my patients and through the stories of political fights and demonstrations for fair funding.

The goal of this blog is to share my perspectives on health care in Chicago and the nation linked to the release of my book COUNTY, Life, Death and Politics at Chicago’s Public Hospital. This book was thirty years in the making. It began when, as a young physician at Cook County Hospital in Chicago, I was struck by how little the public knew about health care delivery and the great gaps in access to care and quality that existed. After seventeen years at Cook County Hospital, I moved to Mount Sinai Hospital in the Lawndale community where I gained a deeper understanding of how structural forces of poverty, joblessness and institutional racism contributed to ill health. I began to write this book in 1995 as a way to digest my experience of the prior twenty seven years delivering care to the medically underserved in Chicago. It reflects my perspective of health care disparity, poverty, racism and quality. As I sit on the Cook County Health & Hospitals System (CCHHS) Board for the past three years, I am struck how the problems we faced thirty years ago have yet to be resolved. A few disclosures: The opinions here are mine alone and do not reflect the opinions of my employer, Rush University Medical Center where I am Chief Medical Officer nor those of the CCHHS where I am a board member. I am a proponent of single payer healthcare and this conviction has been forged over thirty years starting as a medical student and reinforced during my stints at County and Mount Sinai. I welcome your comments and thoughts to my ideas.