Who's running Illinois's Cook County?

With a $3 billion annual budget and a population of nearly 5.5 million, Cook County ranks among America's largest governments. But since mid-March, it's been unclear who is running it.

No one has seen or heard from County Board President John Stroger since he suffered a stroke on March 14, a week before the primary elections – which he went on to win. Family members and doctors have stopped answering questions or providing any updates about his condition.

Officials say he continues to run the government from a distance, in collaboration with his chief of staff, but few of the general public believe it.

Meanwhile, newspaper articles and critics are recalling Chicago's past political embarrassments ("a place where the dead have been known to vote," in an Associated Press story) and suggested that Soviet Russia had more transparency. This situation, they say, is a sign that the old Democratic machine, nearly dead, lingers on in places – and that Cook County is in serious need of reform.

"The county government has been mired in the '50s for a long time here – at least the 1950s, maybe the 1850s – and we're paying a price for that," says David Axelrod, a Democratic consultant who worked for President Stroger's opponent in the primaries. "I'm not sure there are very many places in America where the chief executive could disappear for months, his health shrouded in utter secrecy, and no provision be made for even temporary succession to make sure things run appropriately.... It's devolved into theater of the absurd."

Stroger, Cook County's first African-American president, has been a popular, powerful leader, and was lauded for getting a new $550 million hospital built. Critics see him as emblematic of the old-style patronage politics.

A recent analysis of his campaign contributions found that one-third came from county employees, one-third from county contractors, and "I assume the other third haven't become employees or contractors yet," says Dick Simpson, a political scientist at the University of Illinois in Chicago and a former city alderman. "It's the same old machine Richard J. Daley had, just not as big or as powerful."

Behind the scenes, observers say, the jockeying for power is intense. Stroger's family, including son Todd Stroger, a Chicago city alderman, has promised more information and a decision about Stroger's future by July.

In the meantime, Todd Stroger has floated his own name as a possible replacement for his father. Talk is also swirling around seven or eight other possible contenders to fill the power vacuum, and there is a growing split among the city's South- and West-side African-Americans.

"This is not about government, this is about the mother's milk of Chicago politics – ambition, power, and jobs," says Paul Green, a political scientist at Chicago's Roosevelt University. The situation, he says, is reminiscent of the play "Caligula": "Everybody is praising Mr. Stroger, praying for his health, as they plot to unseat him."

Such a struggle often happens whenever Chicago experiences a power vacuum, says Professor Green, citing the political jockeying that occurred after the deaths of Mayors Richard J. Daley and Harold Washington. He sees today's situation as less indicative of machine politics and more telling about how competitive – and important – local politics are in this city.

"Most other cities don't take their politics as seriously as this," Green says. "It has less to do with the power of the job – it's the honor of the job. It's the game."

Others say the job does matter. While the board continues to function in Stroger's absence, the county needs a leader, they say.

One board member recently released figures showing a $44 million budget deficit that's growing, and the county is currently negotiating contracts with more than 40 unions – including a particularly contentious one with the nurses' union, which is threatening to strike. Some positions need to be filled by executive appointment, and others need to be cut to save money. The juvenile-justice system needs attention, and several FBI investigations involving the county are pending.

"We're becoming a national embarrassment here in Cook County, which is rather a low bar anyway," says Anthony Peraica, a county board member who will be Stroger's Republican opponent on the November ballot.

Mr. Peraica has submitted a resolution, to be considered at Tuesday's board meeting, calling for hearings to determine the actual state of Stroger's health and his fitness to govern. In the event he is declared unable to carry out his duties, the resolution calls on the board to declare a vacancy and elect an interim president.

Several Democratic commissioners have also put forward a resolution, suggesting that if Stroger himself declared in writing that he is unable to do his job, the board would select a temporary replacement and Stroger would continue to receive a full salary and benefits.

The local Democratic Party has until September to replace his name on the ballot. Mayor Richard M. Daley, a Stroger backer, has said he sees no need for an interim replacement.