At one point this afternoon, as Cook County board members argued bitterly over spending plans and revenue projections and a proposal to defer a budget amendment, Todd Stroger sat in a chair away from the fray, laughing uncontrollably.

It wasn’t clear to this observer what amused him so much, but the board president had plenty of funny stuff to choose from. The board is required by law to pass a budget this week, which is a big problem. And it’s a big problem for the same reasons Cook County budgets are always a big problem: the money coming in doesn’t cover both the services that have been promised and the salaries of the thousands of people employed to provide them.

Where exactly it all went wrong for Cook County is a matter for great debate, some of which occurred in the meeting this afternoon led by finance committee chairman John Daley. Some commissioners and county officials chalked it up to the waste and poor judgment of other commissioners and county officials. Budget staff blamed Chicago’s professional sports teams, whose recent mediocre performances have led to diminished amusement tax revenues. Commissioner Mike Quigley, meanwhile, intimated that a few of his colleagues had wasted taxpayer money and everyone’s time by attending the “wild weekend in Washington” that is the annual convention of the National Association of Counties. Commissioner Jerry “Iceman” Butler, a soul music legend and Rock and Roll Hall of Fame inductee, challenged Quigley to “find me another song to sing.” When Joseph Moreno called for order, someone demanded to know what he wanted. “I’ll have two tacos and some rice and beans,” he said.

Somewhere in there was a very serious and thoroughly Orwellian conversation about the dismal state of the county’s public health care system. Last year’s budget slashed millions from health programs, and ever since health workers, analysts, and politicians have said the county’s indigent face long, dangerous waits for care from a greatly reduced and demoralized staff. Self-declared reformers on the board have blamed Stroger and his allies for not saving health funding by cutting fat. The Stroger group has cited the health care system in arguing for additional spending and tax hikes.

But today Stroger’s allies and top county officials, including Dr. Robert Simon, chief of the bureau of health services, offered a different take. They didn’t talk as much about the need to spend more to reduce waits and improve care. They said the board needs to spend more to get additional customers and bring in cash.

“Let’s put it this way: if you have 100 physicians and go down to 50 physicians—because of resignations, and partly because of layoffs—those 50 doctors, all of those people they would see obviously can’t be billed,” Simon said. “It’s all easily explained. It’s all logical and simple.”

Commissioner Forrest Claypool said he agreed, though as usual he reframed the point to place the blame directly on his chief foe, Stroger. “The problem we have here is that the board here cannot make this administration manage,” he said. Stroger had failed to put competent people in charge of the health system’s billing and collections, Claypool argued, and his last budget had protected patronage employees instead of needy residents. “There were bad decisions about where we cut last year as opposed to how much we cut, and we’re going to have to change all that this year.”

Simon didn’t respond directly; he just continued the blame game. “The resignations really started [last fall] when the doctors started seeing the stories in the papers about the lack of support for getting dollars this next year,” he said. He didn’t have to point out that Claypool was one of those unsupportive.