Posted by: Randy Allgaier | July 26, 2006

An Experiment in Universal Healthcare


The city of San Francisco, like the state of California and our nation as a whole, is facing a health-care crisis of unprecedented proportions.

Spiraling costs and the erosion of employer-sponsored coverage have left more than 80,000 San Franciscans uninsured and thousands more underinsured.

These uninsured and underinsured San Franciscans live sicker, die younger, incur crushing medical debt and pass on the costs of unnecessary emergency care to the rest of us in the form of increased health premiums and higher taxes.

The human faces of our health-care crisis are those of San Franciscans like Raul Torres and Patty Senecal.

Raul Torres has worked at a restaurant in the Mission for nine years, but does not have health coverage. Two years ago, he suffered an accident and was treated at San Francisco General Hospital. He now faces $7,000 in bills that he cannot afford to pay.

Patty Senecal worked at a large chain restaurant and was uninsured. For two years, Patty was chronically ill because she could not afford the simple procedure necessary to diagnose her thyroid problem. Patty’s condition worsened until she required surgery, which put her $10,000 in debt.

The failure of leadership in Washington and Sacramento has left California’s local governments struggling to achieve two equally necessary goals: creating a comprehensive health-care option for employers and individuals — like Raul and Patty — who cannot afford health insurance, and financing such a plan in a manner that fairly allocates costs among businesses, individuals and government.

The San Francisco Health Care Security Ordinance represents a groundbreaking effort to do just that.

Guided by Mayor Gavin Newsom’s Universal Healthcare Council, the ordinance would create a Health Access Program that offers comprehensive health-care services to uninsured San Franciscans and their employers at a reasonable cost, with subsidies for small and medium-sized businesses and low and moderate-income individuals.

The Health Access Program would assign individuals to a primary-care doctor, nurse or medical assistant at one of the city’s public or nonprofit clinics, deliver acute care and specialty services through a network, including San Francisco General Hospital and the city’s nonprofit hospitals, and cover prescription drugs and home health-care services.

The program would emphasize preventive care that keeps people out of emergency rooms by providing regular checkups, performing screenings and managing chronic conditions such as asthma, diabetes and high blood pressure.

To ensure that the vast majority of San Francisco businesses that provide health insurance for their employees do not dump them into the Health Access Program once it comes on line, and that all large- and medium-sized businesses pay their share toward the cost of universal access to care, the ordinance also encompasses Supervisor Tom Ammiano’s proposal to establish a minimum health-care spending requirement.

Large businesses employing 100 or more workers would be required to spend at least 75 percent of the cost of individual coverage for a full-time employee, while medium-sized businesses employing 20 to 99 workers would be required to spend at least 50 percent of this cost. The requirement would be pro-rated for part-time workers, and small businesses with fewer than 20 employees would be exempt.

Given that more than 80 percent of the workers employed by San Francisco’s large and medium-sized businesses receive health insurance as part of their pay package from their jobs, and that the Health Access Program will cost far less than market-rate insurance, a minimum health-care spending requirement is absolutely necessary to slow the erosion of employer-sponsored coverage, protect the public health-care system from being flooded, and level the playing field for employers who are doing the right thing.

The San Francisco Health Care Security Ordinance is sound public policy that will ultimately provide universal health care for San Franciscans and create a model for the nation.

Mayor Gavin Newsom, Supervisor Tom Ammiano and San Francisco’s other elected officials should be applauded for their visionary leadership to make affordable, quality health care for all a reality, here and now.

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