By Rachel Gordon
San Francisco Chronicle
November 30, 2006
San Francisco’s groundbreaking plan to provide access to affordable medical coverage for an estimated 82,000 uninsured residents is an opportunity to create a system from top to bottom that could serve as a model of basic care for the rest of the nation.
The Health Access Program, approved by the Board of Supervisors and signed into law by Mayor Gavin Newsom, is intended for adults without health insurance who earn too much to qualify for a federal or state health care plan.
The program will cost an estimated $200 million a year, and will be funded with a combination of public funds, employer contributions and copayments by those enrolled in the program.
(Steve Falk, who heads the San Francisco Chamber of Commerce) said making sure that people have health care is a noble cause — but forcing San Francisco businesses to spend up to $1.60 per hour per employee to fund it isn’t fair.
San Francisco’s program is not like a traditional insurance plan.
Patients will be able to get care only within San Francisco, and most of that care will be delivered at the city-run San Francisco General Hospital and at the vast network of city and community clinics.
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/11/30/BAGJNMMG3L19.DTL
Comment:
By Don McCanne, MD
San Francisco’s intent to bring health care to everyone is certainly admirable. That said, there are so many complex policy flaws in our current system of financing health care that it is impossible to address them on a city-county basis (San Francisco’s unique form of government).
In a town saturated with small businesses with marginal profits, you can question the wisdom of an employer mandate. For many of these businesses, a payroll tax/premium is a financial hardship. Most policy analysts believe that the health insurance link to employment should be terminated anyway, but only after a universal program is enacted.
Another unusual feature is that this is not a safety-net public insurance program in the traditional sense; rather the safety-net coverage provided is the actual safety-net delivery system, comprised of the county hospital and a network of city and community clinics. Many of the uninsured already receive their care from these institutions.
There are many other issues not adequately addressed such as lack of coverage outside of the city, compliance with ERISA regulations, explicit two-tiered care, and, most importantly, a failure to address the true drivers of health care costs and the failure to establish a monopsonistic payer that would demand value in health care purchasing.
San Francisco’s effort is not so much health care reform as it is tax legislation. The health care delivery system remains much as it is, with only negligible changes in access. The uninsured will still have the public institutions as their source of health care. The primary change with this program is that businesses will contribute more, through taxes, to the funding of the public safety net, and individuals accessing the system will be assessed explicit cost-sharing contributions. It is unfortunate that this revenue and budgeting measure designed to benefit the city-county government is being passed off as health care reform.
The next two years presents another window of opportunity for comprehensive reform. San Francisco could accomplish much more in improving the health care of its residents by becoming a very active, high-profile, national advocate of a publicly-funded, universal program of social insurance. And the San Francisco’s throughout the nation need to join in.