Southern Illinois University

Patients don't normally embrace their dentists after getting a tooth pulled, and dentists rarely reward patients with a crisp $5 bill. But this was no ordinary day in Gallatin County, population about 6,500, deep in the hills of southern Illinois on the banks of the Ohio.

A tyke with a toothache so painful he could not focus on learning became the first customer for a dental clinic debuting in a school-based health complex. After the dentist performed the extraction, the boy hugged him, a clinic worker recalls.

Illinoisans have experienced a governmental tsunami without fully realizing it.

The toll mounts daily, and so do the odds against robust recovery. It's not just the smothering deficit. It's not just the lack of political will to confront and correct it. It's also the insidious mangling of a management structure crucial to the effective expenditure of our tax dollars.