San Francisco aims for universal coverage
San Francisco Mayor Gavin Newsom envisions a statewide network of community clinics but admits few counties have the infrastructure, including clinics, that San Francisco had in place.
SAN FRANCISCO – Three years ago, this city turned itself into a laboratory for remaking the country's health care system with a bold experiment to expand services to the uninsured, working poor and medically underserved.
Mayor Gavin Newsom touts Healthy San Francisco as a signature accomplishment – worthy as a model for the nation.
It's too early to tell whether he is right, with researchers only beginning to evaluate the program's early successes and longer-term limitations.
But many eyes are turning toward San Francisco's brand of universal health care. Just last week, Health and Human Services Secretary Kathleen Sebelius chatted with Newsom during a visit to San Francisco, seeking to learn from the city's experience.
"We know that the health care status quo is unsustainable, and we need an American solution to this American problem," her spokesman, Nicholas Papas, said in an e-mail.
President Barack Obama has taken notice, too, praising Newsom, among other mayors, at a White House gathering in February. The Obama administration has made overhauling the country's health care system a priority, and Congress is in the midst of drafting legislation.
"Instead of just talking about health care," the president said, "mayors like Gavin Newsom in San Francisco have been ensuring that those in need receive it."
After years of hand-wringing, San Francisco applied some of the principles now being hotly debated in Washington, such as a government-run health plan and employer spending mandates.
The process began when the Board of Supervisors in July 2006 unanimously adopted the first-of-its-kind Health Care Security Ordinance. The first enrollees joined Healthy San Francisco a year later.
The city established a network of clinics and hospitals, both public and private, to care for its uninsured at an estimated cost of $200 million a year.
To date, more than 42,000 residents have enrolled, which city officials hail as a sign of success toward providing services to its estimated 60,000 uninsured working-age residents.
Qualified residents pay fees based on income. Those at or below the poverty level pay nothing. Those with moderate incomes – up to five times the poverty level or about $54,000 for a one-person household – pay a monthly fee of $450.
Businesses contribute
Even in this self-consciously progressive city – where the question of paper or plastic at grocery stores sparks civic debate – Healthy San Francisco has not been universally embraced.
Among its most controversial aspects is a requirement that local companies contribute to their employees' health care. Companies with at least 20 employees must pay $1.23 toward health insurance for every hour worked by an employee; those with 100 or more employees pay $1.85.
Officials consider the approach essential to prevent companies from abandoning their own group insurance plans and relying on Healthy San Francisco to care for their employees.
The Golden Gate Restaurant Association has asked the U.S. Supreme Court to invalidate the mandate to pay for care. Some restaurateurs have tacked health care surcharges onto restaurant checks.
Daniel Scherotter, owner and executive chef of the upscale Palio d'Asti restaurant, says the health care spending mandate is adding to hard times. Beyond the recession, San Francisco's minimum wage is the state's highest: $9.79 an hour.
"When you add up all these costs, you have to take an ax" to cut jobs, Scherotter said. "I'm a chef. The last thing I want to do is take an ax to my kitchen."
S.F. plan is not a cure-all
Early drafts of federal legislation meant to overhaul the country's health care system have drawn similar opposition from business groups. One draft is under fire for its $1.6 trillion price tag.
A key component of the current proposals is a public health plan that would compete with private insurers – which supporters say would bring down the cost of premiums.
Overhauling health care, Newsom told The Bee in a recent interview, is "probably the most debated, most discussed, least acted upon issue today."
Indeed, the high cost of health care long has been a national concern. In 2007, the health care industry accounted for more than $2.4 trillion in spending, or about 17 percent of the gross domestic product, according to the National Coalition on Health Care.
By some counts, more than 46 million Americans are uninsured; 6.6 million of those live in California.
With health care costs rising, the poor and uninsured put off routine medical care, said Kit Chan, a nursing manager at the Chinatown Public Health Center, a city-run community clinic that helped launch Healthy San Francisco two years ago.
As they get sicker, they seek help – sometimes ending up in the city's emergency rooms, Chan said, where caring for them costs far more.
Chan's clinic serves more than 5,000 patients, primarily immigrants from working-class neighborhoods near downtown. About a third of them now are enrolled in Healthy San Francisco.
San Francisco's health care program is not a cure-all. It does not cover dental, vision and long-term care, and it's available only to those who live within the city's boundaries.
"There definitely needs to be more fine-tuning. It's a little hard for us to meet demand," Chan said. "But it's helping."
Clinics linked electronically
Newsom envisions a statewide network of community clinics but acknowledges that few counties have the infrastructure that was already in place in San Francisco, including its robust clinic system.
"We are not arguing that this is going to be easily replicated," he said. "But we do believe there is remarkable capacity in a state like California to build on this plan."
Healthy San Francisco participants can seek basic care at any of 29 public or nonprofit neighborhood clinics, which are linked by an electronic record system, enabling continuous care from one facility to the next.
In Sacramento, by contrast, budget cuts have led officials to close clinics, cut staffing and reduce services.
A cookie-cutter approach won't work for every community, but the core principles could be worth emulating, according to Marty Keale, executive director of Sacramento's Capitol Community Health Network.
"There's no model that can be lifted in its entirety from one area to another," he said.
Daniel Scherotter, owner and executive chef of Palio d'Asti restaurant, says San Francisco's health care spending mandate is making things even more difficult in the recession. Some restaurateurs in the city have tacked health care surcharges onto restaurant checks.