I am a physician in internal medicine working at Cook County. Board President Todd Stroger and his appointed health chief, Dr. Simon, have made plans to cut nearly 1/5 of the health budget of Cook County. The just-released 2007 budget is the first step toward deeper cuts. The depth, speed and indiscriminate nature of the cuts mean that tens of thousands of Cook County residents with no other means to access health care will suffer dire health consequences. Even death. This may sound melodramatic, but it is also most certainly true.

The Cook County Bureau of Health Services-which includes three hospitals, many health centers, the Department of Public Health for suburban Cook County and the jail health services-is not a model of efficiency. A recent survey revealed a solid majority of county employees believe their co-workers are not well managed and putting in their full effort. I imagine a similar survey of patients might reveal a deep loyalty to Cook County as a health care institution but a dim view of many county workers.

In addition to this slack and lack of management, there is incompetence. The Bureau of Health Services, necessarily relying in part on taxes, but sadly lacking the administrative capacity to properly bill Medicare, Medicaid and insurance companies, has failed to collect on hundreds of millions of dollars in reimbursable health care. The system has slid by without this basic financial accountability because tax money, including through federal matching programs, has provided the operating dollars. The easy and seemingly justifiable path is to throw up our collective hands and let Todd Stroger cut deeply across the board. How can this bureaucratic behemoth be defended?

The flip side is the reality of an institution that serves the least among us. The 55-year-old grandmother with diabetes and hypertension, a Brach’s job that just left for Brazil, a daughter checked out on drugs and two grandchildren in tow will all have an impossible time finding and paying for health care without Cook County.

Even with self-interest alone to consider, we should be compelled to provide care for this woman because in a year or two she will be back with a need for long-term care for her stroke or for the incredibly costly debacle of dialysis. Or consider a young man without insurance with symptoms of tuberculosis or a sexually transmitted disease. This young man will be hard-pressed to find a place to get timely diagnosis and treatment, and it will be the public that is put at risk-our sons and daughters. And, of course, any of us falling victim to a drunk driver and air lifted to a trauma center will lament the gutting of the Cook County Bureau of Health Service.

Ambivalence is too easy. We must have cuts at Cook County that are precise by cutting unneeded positions carefully, but preserving the ability of the system to serve, especially in the arena of health care. We need competent Cook County administrators who can budget sensibly, collect revenue responsibly and hold each employee accountable for jobs well done. Mindlessly cutting 17 percent across the board will devastate health services while preserving 83 percent of the patronage and 83 percent of the non-performing employees.

What can you do? Find your commissioner at Cook County’s website and call him or her today. Tell them you expect change but that gutting health services is morally wrong and will endanger the public health of Cook County.

Ask them to look at revenue increases, including properly billing for services and getting a fair share of state money, rather than forsaking those in most need. We do not need to sink into a dystopia where we abandon the sick and destitute among us.

Call your commissioner and let them know you care. Let them know you are watching.

Gregory Vachon, M.D., is medical director of the Austin Health Center of Cook County and an Oak Park resident.