Ron Shansky and Healthcare in the US: We need more than buildings

I recently attended a memorial in Chicago for my dear friend Ronald M. Shansky, who died late last year. In addition to being a terrific human being, Ron was a physician and an advocate for – and provider of – health care for the incarcerated. He served as medical director for the Illinois Department of Corrections, was a leader in writing the standards for correctional health care for the National Commission for Correctional Health Care (NCCHC), and served in many court-appointed roles for jails and prisons after lawsuits by prisoners. He was very serious about his work and did whatever he felt necessary to fully understand the problems that existed and solve them. For example, in the 1990s when he was the court appointed receiver in the DC Jail, he slept in a cell and had his office in another. He was also a committed father and husband and brother and cousin and friend, as even I learned more about during the memorial, hearing the stories told about him.

It was appropriate, but also a bit ironic, that the memorial was held in the old “main building” of Cook County Hospital, now a Hyatt Place, where Ron (and I) worked for many years. He continued to see patients there one day a week even when he had moved on to doing other demanding jobs. “County” is where I got to know him, and where he got his start in jail and prison health when Department of Medicine Chair Quentin Young sent him and his colleague Lambert King to fix the medical care at the Cook County Jail. There are still parts of the interior that are preserved, including marble and stone floors and staircases, and we tried to remember what was where; the memorial itself was in the area that was originally the Medical Director’s office.

The former main building of Cook County Hospital

“Last Rounds”, 2002 Reunion of former Cook County Hospital residents as the hospital closed

Only part of the original main building of the old Cook County Hospital is left, replaced by the newer John H. Stroger Hospital of Cook County.  While I worked at the old “County” for 17 years, I had trouble getting my bearings with the changes in geography. The whole area is called the Illinois Medical District, and includes much besides the County facilities. Immediately to the south is the University of Illinois medical center, including its medical school and hospital; to the north is Rush University Medical Center and its medical school and hospital. While both were there when I started at County 50 years ago (indeed, at one point there were two other medical schools in the immediate area, Loyola and Chicago Medical School, both of which are now in suburbs), they have expanded and grown and cover incredible amounts of real estate, more than a mile east to west and at least a half mile north to south. University of Illinois buildings stretch to the west, almost a half mile farther than they ever did, while Rush buildings spread to the east. In the mid-1970s, Rush proposed closing a block of Paulina Street that would be in the middle of two of its buildings as they expanded east. Many of us opposed it and demonstrated against it as it would cause a several block detour for ambulances (and workers) coming from the Eisenhower Expressway to County and U of I. But they closed it, and built, and now Rush extends many blocks further east.

Two demonstrators against the closure of Paulina St. by Rush, 1979

The West Side of Chicago, where the Medical District is located, is historically a low income and largely Black community. Even in the 1970s, the presence of these hospitals in the midst of a poor community with poor health seemed ironic. Today, despite the gentrification of the immediate area from the hospitals’ expansion, it still is. The massive expansion of the Illinois Medical District’s hospital and support services is replicated across the county in big cities (forget the rural areas, where hospitals have been closing), in New York and Los Angeles, and Houston, and Atlanta, and Birmingham, and Denver, and on and on. If the health of our population could be measured by the real estate occupied by medical facilities, we would be healthy indeed. The sheer amount of money needed to build these bigger and bigger hospitals, and professional buildings, and Heart Centers and Cancer Centers and Orthopedic Centers and Neuroscience Centers is staggering. As our society pours billions and billions into “health care” as manifested by these buildings, we should have surely eliminated suffering, or at least lead the world in health. 

But we do not. Not on the West Side of Chicago, or all of Chicago, or Illinois, or the US. Instead, the US, year after year, trails the rest of the wealthy world (and many middle-income countries) in virtually every marker of health status. As demonstrated by the most recent (2024, see graphics below) Commonwealth Fund report “Mirror, Mirror, on the wall”, the US continues to lag as it has for decades. Except, of course, in spending where, amazingly, the US spends a lot more money than any other country to get these worse results. This is because a huge part of the billions and trillions of dollars being spent in the “health care sector” is not spent on delivering health care – or even medical care – at all. It delivers, first and foremost, enormous wealth to the insurance companies and pharmaceutical industry, but also to the health systems – public, private “not for profit”, and private for-profit – that have constructed these expansive edifices.

Across the street from the old Cook County hospital is Pasteur Park, named for the state of Louis Pasteur that stands there. Inscribed on the back is a quotation from him,

“One does not ask of one who suffers: What is your country and what is your religion? One merely says: You suffer, that is enough for me..."

That was the fact in the old Cook County Hospital, and it is something health workers should not only remember but fight to make reality in the fact of concerted efforts to make it not so.

Pasteur Monument, Susan Ives

Ron Shansky for his whole life fought for a health system that would care for not just the wealthiest or best insured, but everyone. He cared for people at “the County” and those in jails and prison. He never stopped fighting for universal health care. He always believed that money being spent under the rubric of “healthcare” should actually be spent on delivering healthcare to those in need, echoing Pasteur. He thought it immoral, unacceptable, and indeed criminal that so much of that money was going into the pockets of health insurance and health system executives, of shareholders in insurance companies and private equity, in building more and more buildings that, while they provide services that help individuals, did not and do not appreciably improve the health status of “the people” taken as whole. To judge the health of a society you need to look at all the people, not just those that have the best financial access to care (although, sadly, in the US, many of those who are insured are much worse off than they should be).

We need to honor Ron Shansky, and Louis Pasteur, and the people of our nation and the world, by ensuring our healthcare dollars are being efficiently and effectively spent on improving the health of our people.

Ronald M. Shansky, MD