Scaling San Francisco's Universal Health Care Program

I've been in our nation's capital this week meeting with Obama Administration officials and Congressional leaders about national health care reform. Everywhere I go, from the White House to the Department of Labor to the U.S. Senate, I get the same question: can San Francisco's universal health care program, Healthy San Francisco, be scaled?

The answer is yes.

Truly, one of the strongest aspects of Healthy San Francisco (HSF) is its simplicity. The program allows participants to select their primary care provider from among dozens of local hospitals and clinics, both public and private. Our local system does not require lengthy HMO paperwork and there is no denial of treatment based on pre-existing medical conditions.

A recent study showed that Healthy San Francisco is dramatically less expensive than traditional insurance. And our experience in San Francisco is proving what most Americans already know - it is much less expensive to keep people well than it is to treat their sickness, particularly when so much treatment for uninsured Americans is provided in costly emergency rooms.

There are currently more than 40,000 participants in HSF. We are enrolling approximately 600 new participants every week. We have already enrolled more than half of the previously uninsured San Franciscans and the vast majority will have access to health care by the end of next year.

I believe that administration and congressional leaders understand that we cannot wait for health care reform. Our health care crisis affects every aspect of our society - from making sure every child receives the health care they need to succeed in school, to decreasing the financial burden on business, both large and small, so our economy can get back on track.

I know there is pressure in Washington to wait until the economy improves before we act on health care reform. I faced many of the same pressures when I was working with allies in San Francisco to forge our universal health care delivery system.

But "waiting" in politics usually means never - and we simply cannot afford to wait any longer. The lessons we are learning in San Francisco shows that investing in health and wellness is its own kind of economic stimulus.

The time is now to tackle this problem and I applaud President Obama for promising to sign a national health care reform bill by October. We cannot wait for change - the President needs your help. Sign the petition to support President Obama's call for health care reform.

One of the key figures leading the charge in Congress is Iowa Senator Tom Harkin. I spoke with Sen. Harkin on my Green 960 radio show this week about the challenges Congress and the administration face and the possibility of using HSF as a model for a national program. You can listen to the show online or via iTunes.

For my part, I was recently made Chair of the U.S. Conference of Mayors Task Force on Health Care Reform. Cities often have the most pressing health care needs and have had to adapt and innovate in lieu of national health care reform. I am looking forward to working with my fellow Mayor's to hear what they have learned in their cities and share what we've learned in my hometown through Healthy San Francisco.

In the end, the task force will identify urban health care priorities and advise the work of Congress and the Administration to help solve this crucial challenge we all share. As always, please feel free to give me your input and feedback in the comments section below.

Listen to Mayor Newsom's Green 960 radio show online or subscribe to his weekly policy discussions on iTunes. Join Mayor Newsom on Facebook. You can also follow him on Twitter.

Comments

[milk67]

Ok. Time for some reality instead of the undeserved self congratualtory nonsense from camp Newsom (check this link for the just released grand jury report on the lies newsom tells about his record--http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/08/BABI17GR6G.DTL&hw=newsom+grand+jury+report&sn=002&sc=521---healthy SF is NOT universal health insurance and only covers 78,000 of 780,000 residents. Patients pay a sliding scale for treatment (sometimes up to 500 dollars or more per dictor visit)at local hospitals only. Newsom sat on the sidelines while Supervisor Tom Ammiano wrote and negotiated the legislation. Newsom then delayed it's implementation for months and put together a "panel" to study it. After 8 months he held a press conference announcing it's implementation and tried to associate himself with it for politcal gain, but was off partying and vacationing (Newsom vacations more than BUsh did) while it was being ironed out. He constantly acts like he wrote the legislation to the press outside of SF. We in SF know better. Newsom is a terrible mayor, a snake oil salesman and dishonest to boot. Don't let him snow you. reda the local press coverage of him and his incompetence and political opportunism. He talks the talk, but he absolutely doess not walk the walk. Eevryone in SF supports gay marriage. No one supports Newsom anymore.

[YellowDogInRedCounty]

TAKE.THE.PROFIT.OUT

http://manalive123.blogspot.com

[onlinesavant]

Why is it that when we hear of "universal health care" "successes" in the U.S., it always revolves around Mass. ? Ususally with the fallacy being pushed that it is successful, and that mitt romney created it, when it was the Democratic legislature that pushed it, and it is not as successful in covering all it's citizens as San Francisco's apparently is?

[Rocks911]

Too bad the only people sitting at the table to discuss national health care reform are HMO's, insurance companies and drug companies. Max Baucus who chairs the Senate Finance Commitee has received more in contributions from these imterests than any other Democratic Senator and has chosen to leave any single payer representative out of the debate. He has left the debate to all the usual players.

Outrageous!

http://crooksandliars.com/susie-madrak/ed-schultz-insurance-companies-are-ta

[juanjo]

I currently pay 536.00 a month for health net and that is through a group plan at work. I have done volunteer work with people who were on the street or who were employed in jobs where they received no health care benefits. Now they are enrolled in healthy SF and they are receiving decent health care for the first time in their lives. They are not going to SF General emergency room or other private hospital emergency rooms for their medical care which is far more expensive. The end result is a cheaper tax burden for those of us who live in the city and better care for people who need it.

[thinkagain2]

boy, that sounds exactly right. We are paying for other's healthcare whether we think its a right, a responsibility or a purchased privilege everytime someone without insurance shows up in the emergency room for illnesses that could be easily treated in a clinic.

I don't know why this is so hard to understand. Health care for all is cheaper by far than our current caste based system.

[urgk]

"We are paying for other's healthcare whether we think its a right, a responsibility or a purchased privilege "

Thinkagain2, you should shout that at the top of your lungs every chance you get. The Big Lie is that if we don't pay for social programs, we don't pay at all. It's the basis of the Republican platform. If you don't try to fix things through taxes and government programs, the theory goes, you keep your money.

Well, that isn't the case. if you don't pay for education now, you pay for prisons later. If you don't pay for health care now, you pay higher premiums later. If you don't pay to do something about the horrific poverty and social stagnation that greed has wrought, you pay for taller fences, a home security system, a hidden premium from stores who shoplifters target, more police, etc.

We wastes too much time as Democrats ad Progressives, pretending that the Right has an equally valid point that's up for debate. We need to step up and show Republican ideology for what it is -- a means of keeping the hyper-wealthy wealthy, while the rest of us deal with the realities below. For us, it isn't a choice between paying or not paying. It's a choice between paying now in an attempt to actively make the country better or paying later in an attempt to just keep it from collapsing.

[zizyphus]

I like that - "caste based system", very apt.

[calirighty]

Mr. Newsome, once again you miss the point. It is not my job as a tax payer to pay for someone else's health care regardless of whether they are sick or healthy. So your argument is a moot point.

[richchaplin]

It IS your job as a tax payer to pay for health car of soldiers, firefighter, police officers, highway workers, etc.

[preemptivelove]

wow, how pathetic. like a typical "righty", you miss the point as usual.

YOU ALREADY ARE PAYING......in a dramatically reduced quality of life. the emergency rooms you rely on are grossly overburdened. the economy is in the toilet in part because businesses in this country have astronomical costs associate with healthcare benefits so they cannot compete with other nations. HMO's and insurance companies are reaping HUGE profits, while America gets increasingly less healthy. you're not thinking this through, and your knee-jerk republican stance about bootstrapping and welfare doesn't hold any water any longer. surely it's not your job as a tax payer to prop up executives from goldman sachs, but yet you do it. we've had 8 years of doing it the "right" way.......now let the smart people have a crack at it.

[thinkagain2]

Yep. My company's very conservative insurance and benefits rep says exactly the same thing. He even changed parties and voted for Obama. He thinks we are all getting ripped off and the resistance to universal (or whatever) healthcare is going to bankrupt us far more than gov't spending on the bailouts or budgets or stimulus packages.

[zizyphus]

The litmus test for a society is how it treats it's most disadvantaged members. In your ideal world, you would be stepping on the broken, aching backs of the poor on your way to the bank.

[quiviran]

But you are willing to pay for it in the form of higher prices for you automobiles, financial services, groceries, etc, because those employers provide workplace based health insurance? You actually think you are an island unto yourself? Ask not for whom the bell tolls…

[Billl]

Free health care can be provided for every individual and business that chooses to use a new government owned and operated National Health Care System, funded by a national sales tax, no insurance, no co pays, no precondition denials.

Anyone wanting to use existing systems can continue to pay for and use them.

Costs of health care paid for by government programs, (Medicare-Medicaid etc.) and proposed free government care could be reduced to a fraction of current expenditures, with better outcomes, if the services for these programs were delivered from a VA style National Health Care System.

A VA style National Health Care System, which controls the problems with access, cost, quality, and malpractice, is THE solution for America’s healthcare problems.

Businesses choosing national health care as the provider for their employees would be freed from the expense and hassles of being involved in any way for the health services their employees receive.

The Best Care Anywhere is an article by Phillip Longman that documents how the VA was transformed by Dr. Kizer, into a system that is producing the highest quality health care in the country. http://www.washingtonmonthly.com/features/2005/0501.longman.html

The system could be jump started by acquiring health delivery systems around the country that would choose to sell to the new National Health Care System.

[blacknblue2]

Hey Bill,

Can you show me a plan in the entire world that doesn't have copays or coinsurance?

Canda has out of pocket expenses, so does the UK, Germany, Japan, Tiawan France ......need I go on? Your wants out pace the reality of the world.

Have you even spent one ounce of energy looking at how the rest of the world works or is your head so far up the canal that you don't want to see?

[quiviran]

Easy to call names, absent facts. Wales and Scotland have abolished co-pays completely. England out of pocket expenses average less than $30 per month, most of which is the point of sale flat rate cost for prescriptions. The point is, if the costs are being borne by the taxpayers anyway, why build a complex system to shift a small amount of those costs to the individual?

My last procedure under my employers plan cost me about $400 out of pocket. It happened to be my only claim for the year, so it included the $200 annual deductible. The bills were distributed among 4 different medical practices, each of which had to bill both me and the insurance provider for our respective fractions. There are about 850 medical insurance providers in the country and the medical practice has to know how to bill each one. Waste of effort.

Try this for comparison: http://www.npr.org/news/specials/healthcare/healthcare_profiles.html

[MJinCanada]

Regarding "co-pay" in Canada: there's no co-pay for going to see your doctor or getting medical treatment, but there are fees for certain things, which vary from province to province. If you need a physical for a job or for an insurance claim, you pay a fee for the doctor's report (around $50) but not for the physical.

When I broke my ankle and needed surgery (plate and screws), all I had to pay was $35 for renting crutches for six weeks.

Dentistry and glasses are not covered except for children of low income in some provinces, so many people have some sort of additional plan to cover these, usually through work, because $1600 or so for a root canal and crown is a bit much all at once.

[thinkagain2]

I mostly agree with you, except that I think that no one should expect healthcare without any copay or deductibles. It isn't the treatment for common cold or allergy symptoms that we should be insured for...its the catastrophic or chronic conditions. Under a broad health care reform, the individual's responsibility to adopt a healthy lifestyle and to take care of simple illnesses should be paramount.

[BottomLine2008]

"Whether we like it or not?"

When are you going to apologize for tanking the No on 8 campaign?

Shouldn't you be dealing with San Francisco's huge budget deficit instead of spending a week outside the state?

[zitlight73]

It's been over sixty years since Truman purposed his health care plan and every since national health-care has been soundly defeated. I'll be pleasantly surprised if Obama gets a viable health-care plan passed but being a skeptical if not cynical independent I have my doubts. There will probably be enough Democrat paid of by the powers that be to either defeat national health-care or have it watered down enough to keep that health-care lobbyists' money rolling in. Just like in their continuation of the Iraqi War and the expansion of the Afghan War to keep their masters in the military industrail complex happy and on many other front I don't see much daylight beween the Democrats and Republicans, they represent an illusion of choice at best.

[RepugsOut08]

While your frustration is understandable, do you think we'd even be looking at health care under McCain/Palin? In fact, McCain's stimulus proposal was 500 billion in more tax breaks for the wealthy. He'd have us in a full blown depresion by now.
I might be naive, but I think having a president who watched his mother fight with insurance companies as she was dying of cancer, is going to make the difference this time.

[zitlight73]

I still have some hope but not much. There's too much corruption on both sides of the aisle. The Democrat will give health-care alot of lip service but in the end there will just enough blue-dog Democrats like the newly aquired Specter to kill any meaningful health-care reform.

[Amber Moller]

This all sounds great, but I'd like to know what the provisions are for people with preexisting medical conditions, such as Lupus. This could be a great option for those that don't already have insurance...but what about those of us who need affordable and reliable health coverage?

I'm rooting for you, though! I'd like to see this happen.

[RepugsOut08]

If you have a preexisting condition, you need to really fight for reform.
Watch Michael Moore's "Sicko," and you'll see how countries like Canada, Great Britain and France deal with this issue, and how their people REALLY feel about their "socialist" health care system.
We've been lied to by the few who profit obscenely from people's misery.
My neighbor just had two operations that totaled 100 grand. Luckily, she's now on "socialist" Medicare, or she would have been instantly 20 thousand dollars in debt paying deductables.
It's time for this for-profit­-insurance­-driven insanity to stop.

[jinxed]

for-profit­-health-in­surance is immoral and should be illegal! NO EXCEPTIONS!

[blacknblue2]

You've also been lied to by SICKO.

I am not saying those other countries are bad but SICKO left out a hell of a lot of detalis.

All those plans that SICKO showed you are in debt up to their eyeballs. As fast as they can they are adding higher co-pays, co-insurance, cutting back on services etc.

I did a study of most all world plans and got depressed. On the surface they all work but once you start looking it seems nothing works as it did at first glance.

Take Japan, a model many in Obama's admin like. You will find that doctors see too many patients. This dilutes the services provided. In outpatient care, a clinic physician sees an average of forty-nine patients per day; 13 percent see more than a hundred. While patients have ready access to care, consultation times are short, and patients end up paying repeat visits to the clinics.

Did you know in France you pay first and then get paid back by your insurance company?
If you are subscribed to the French social security, you need to send a completed form (feuille de soins) to your CPAM (Caisse Primaire d'Assurance Maladie). Reimbursement takes usually 2-3 weeks.

85% of French also pay for supplement insurance to cover what the other plans don't cover.

There is no preexisting stuff in the other plans, Germany could place a Tariff on your private plan.

[fjgallagher]

All well and good, Mr. Newsom.

I'm curious what your plan is to keep the state from sliding into bankruptcy. I'm sure you saw the story in the LA Times this morning detailing how the state will be out of money by July. Not to diminish the importance of increased access to health care, but with all due respect, the problems California faces go far, far beyond that policy question.

How, given the constraints inherent in the California state constitution, will you as Governor affect the structural changes that will have to occur for California to continue as a viable entity?

My sense is that questions like this are beyond your rather limited capabilities.

[goodgravy]

good question. and, BTW, have you tried to figure out the ramifications of voting for/against the Props on the ballot? i'm having a terrible time understanding it all.

[RepugsOut08]

This is why we need a NATIONAL health care system, so the cost is spread out. Just as it shouldn't be the responsibility of SF to come up with it's own army, or any other national government entity that currently deals with protecting life and health.

[mharad]

Gavin--

You always seem to omit the spiraling cost this is adding to every San Franciscan's cost of living, like the 4% universal health-care surcharge that is showing up on practically restaurant tab. Or how about the $35 per month surcharge we now have to pay our pre-school (where the teachers already receive outstanding health benefits). The costs of this plan on mid-size businesses are just crushing, especially in this economy, and no one will be surprised as more of them pass these costs onto consumers.

Healthy San Francisco will probably cost my family $500 - $700 (after tax, of course!) just in 2009 and we get absolutely nothing in return.

[ProudLiberalDan]

Perhaps you should move to a red state where you won't pay high taxes, but then you won't get any government services either. And you'll of course go without all the cultural advantages of living in a modern, cosmopolitan city.

They are lining up to replace you in San Francisco.

[goodgravy]

what is your share of health costs for the uninsured that use the ER?

[mharad]

Love san francisco, but tired of being treated like an ATM machine by Mayor Newsom and especially our lunatic Supes. I'm a business owner in the City as well, so I get to pay for Healthy San Francisco out of our profits as well.

Our costs to pay for the uninsured is a fair question, and I don't know the answer to it. But I do know that I get to pay thousands more through our business and probably $600 more per year through cost of living increases. Tell me where I'm seeing the reduction on the other side of the ledger.

Oh yeah, and don't have a heart attack across the bridge in Oakland...Healthy San Francisco doesn't cover you outside of the City.

[joetherealist]

$41 to $58 a month is "crushing"? And you live in SF?

[blacknblue2]

Joethereal­ist....tha­t is funny but true. If $41 to $58 is crushing how the hell are you living in the City?

The house I sold in 1986 (Ingleside terrace) for $225,000 was recently selling for $900,000. I am so glad I moved away. I now have a house twice the size and 2.5 acres of land.

[grayshield]

This is what I want to know about this --

What does your regular health benefits provide that Healthy San Francisco doesn't? Because my understanding of universal health care is that you wouldn't need traditional insurance, but it sounds like you're paying for both. In which case, yes it is a detriment to you rather than a benefit.

I will say that right now, I pay about $700 on insurance as a single person through my company -- and that only covers a portion of my actual fees. It's an additional $30 processing fee to actually visit a doctor, plus $15 co-pay. And the yearly health screenings I have to get for a pre-existing condition are a couple hundred out of pocket each time. So if there was a universal health plan that covered everything and only cost me $600 - $700 out of pocket a year, sign me up.

And all of my costs are massively cheap compared to my friend who pays $200 monthly for basic insurance, because she's an independent contractor. She lives in LA, which isn't that far behind SF when it comes to cost of living.

[Heartlight3]

I live in Hawaii and I wish I could find a health plan that would only cost me $200 per month. As a single person and an independent contractor, I pay close to $400 per month, and that does not include copays or prescriptions. I'm for a single payer public option. Even if my taxes would go up a bit, it would not be as much as the $4800 per year I pay for health insurance now.

[blacknblue2]

They don't care about cost. It is all about how they make the needy feel? Make them feel good and all is well.

Why did my friend that lives out on 19th ave ask me.....will it be civil war or revolution?

[RepugsOut08]

Well, heaven forbid anyone makes the needy feel well.
Bring on your idiotic civil war and revolution against a president who is trying to help every American citizen get ahead, and who isn't just focused on the wealthy.
Drag your "warriors" out of their musty millenium bunkers, and just try to organize this ragtag bunch of no-nothings into a cohesive force against themselves. WTF are you thinking?

[urgk]

It's not all about feelings. That's just a diversion to make Progressives look like hippies -- flitting around hugging trees and whispering to the earth to ask its forgiveness.

Let's try practicality for a minute. Let's try it your way. Sick people don't get taken care of. What happens?

Effect #1: They're more likely to spread disease.
So?: Disease spreads. Darwinian forces give bacterial and viral diseases more time to hone their biological skills for getting into and destorying human beings. More insured people get sick. Your insurance premiums go up.

Effect #2: They die. And rot.
So?: You pay city workers to cart them off. And, let's not forget, you pay for health care benefits for those city workers, you pay for their office space, you pay for their disposal vans, you pay the burial or incineration fees, etc. Your taxes go up.

Effect #3: There is no social promise of reciprocity.
So?: We all lose something that has made civilization worthwhile -- the notion that we treat others well, because at some point we may need help too. There is psychological unease. More people need prescription pills. Your insurance premiums go up.

This isn't about paying or not paying. It's about how much to pay and when. The U.S. is a car we all own. We can't just sit there by the side of the road saying "I don't want to pay for an oil change. The stupid oil should just change itself."

[Bethab]

I don't live in Cali, but I wish I could vote for you!